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Geriatric medicine

Diseases associated with aging are diseases that are often seen accompanying an increase in the rate of physiological aging. In general, we can say that diseases associated with aging are complications resulting from aging. Physiological aging. We must distinguish between diseases associated with aging and aging itself. All humans and animals age, but there are only exceptional cases of them who suffer from diseases associated with aging. Not every elderly person suffers from diseases associated with aging, while everyone who suffers from diseases associated with aging is elderly. Diseases associated with aging is a term that means “diseases of the elderly.” Diseases associated with aging must be distinguished from diseases of accelerated aging, although they are all caused by a genetic disorder. Examples of diseases associated with aging include the fact that the incidence of these diseases increases with age, and in the case of cancer, the rate increases many times over. Approximately 150,000 people die every day in the world, 100,000 of whom die from diseases related to age, and in industrialized countries the rate reaches 90%. Different patterns: 30% of mice develop cancer by the time they are three years old, while 30% of humans develop cancer by the time they are 85. People, dogs and rabbits get Alzheimer's disease, but rodents do not. Older rodents often die from cancer or kidney disease, not cardiovascular disease. Cancer rates in humans increase dramatically with age but may decline or stop by age 60-75. People with progeria or senility are at risk for many diseases. People with Werner syndrome have but are not at risk for Alzheimer's disease or neurodegeneration. People with Down syndrome have type 2 diabetes and Alzheimer's disease but are not at risk for high blood pressure, osteoporosis or cataracts. People with Bloom syndrome often die from cancer. Research: Age increases the risk of diseases associated with aging, while genes reveal who is susceptible and who is resistant among species and individuals within a species. For example, there are some changes that are often seen with age, such as the common saying that it has nothing to do with the death rate, but there are some specialists in the science of aging and everything related to the elderly, biogerontologists, who believe that there are changes that are not yet known or invisible behind the appearance of white hair, and this invisible factor increases the rate of malfunction of the rest of the body's organs, which accelerates the death of the organism. They claim that understanding and accepting the concept of diseases associated with aging will enhance and advance the biology of the elderly, just as knowledge of childhood diseases advanced knowledge of human evolution. Strategies for Engineered Negligible Senescence SENS is a systematic research institution that aims to correct some of the root causes of diseases and malfunction of vital functions associated with aging and to develop medical procedures and follow-up periodically to correct all the imbalances that affect the human body, and thus maintain eternal youth in the literal sense. SENS has developed a program that includes 7 factors that cause vital malfunction related to aging and has identified solutions for them. However, critics say that SENS has greatly exaggerated, to say the least, and that aging is a complex process and the knowledge that SENS has does not qualify it to be scientific or applicable in the near future.

Geriatric medicine

Elder abuse is the neglect or mistreatment of older adults by someone responsible for their care. The abuse can be physical, psychological, or financial. Elder abuse can occur at home, in residential care, or in the community. Elder abuse is a serious social and health issue that affects more older adults in Canadian society. It is estimated that between 4% and 10% of older adults in Ontario experience some form of abuse. Harm to older adults includes harm to people they know or have a relationship with, such as a spouse, partner, family member, friend, or neighbour, or people the older person relies on for services. Many forms of elder abuse are considered types of domestic violence or family violence because they are perpetrated by family members. Some paid caregivers have also been known to abuse their elderly patients. There are a variety of situations that constitute elder abuse, but they do not include general criminal activity toward older people, such as home invasion, street “robbery,” or “distraction burglary,” where a stranger distracts an older person on the doorstep while someone else enters to steal their belongings. Elder abuse by caregivers is a global problem. In 2002, the World Health Organization brought international attention to the issue of elder abuse. Over the years, government agencies and professional community groups around the world have identified elder abuse as a social problem. In 2006, the International Network for the Prevention of Elder Abuse designated June 15 as World Elder Abuse Awareness Day. A growing number of events are held around the world on this day to raise awareness of elder abuse and highlight ways to challenge such abuse. Although some older people with dementia or mental illness make false accusations of theft and other forms of abuse against caregivers or family members, all reports of abuse should be investigated. Although there are common themes of elder abuse across countries, there are unique manifestations that depend on the history, culture, economic power, and societal perceptions of older people within countries. The primary common denominator is the use of power and control by an individual to influence their peers and the status of an older person. There are several types of elder abuse that are generally recognized as elder abuse, including: Physical: such as hitting, punching, slapping, burning, pushing, kicking, restraining, unjustified imprisonment/confinement, giving excessive or inappropriate medication, withholding treatment and medications. Psychological/emotional: such as humiliating a person. A common feature is that the perpetrator identifies something that is important to an older person and then uses it to coerce them into doing something. It may take verbal forms such as yelling, name-calling, ridicule, constant criticism, accusation, or blaming, or it may take nonverbal forms such as ignoring, silence, ostracism, or withdrawal of affection. Elder financial abuse: Also known as financial exploitation, it involves the misappropriation of financial resources by a family member, caregiver, or stranger, or the use of financial means to control a person or facilitate other types of abuse, and sometimes the failure to provide financial support to poor older adults in jurisdictions with caregiving responsibility laws, such as France, Germany, and most of the United States. Sexual abuse: For example, forcing a person to engage in any sexual activity without their consent, including forcing them to engage in sexual conversations against their will, which may also include situations in which the person is no longer able to give consent. Neglect: For example, depriving a person of appropriate medical treatment, food, heat, clothing, rest, or essential medications, or depriving a person of services necessary to enforce certain types of actions, financial or otherwise. Neglect can include leaving a vulnerable older person unattended. The deprivation may be intentional or occur due to a lack of knowledge or resources. In addition, some state laws also recognize the following as elder abuse: Abandonment: Abandoning a dependent person with the intent to abandon or leave them unattended in a place for a period of time that may endanger their health or care. Abuse of rights: Denying an elder’s civil and constitutional rights, or failing to inform a court that they are mentally incapacitated. This is an aspect of elder abuse that is increasingly recognized and embraced in various states. Self-neglect: Anyone who neglects themselves by not caring for their own health or safety. Self-neglect is treated as conceptually different from abuse. Elderly self-neglect can lead to illness, injury, or even death. Common needs that older adults may deny or ignore include: sustenance, hygiene, adequate clothing for climate protection, adequate shelter, adequate safety, clean and healthy surroundings, medical care for serious illnesses, and essential medications. Self-neglect is often due to a person’s reduced awareness or mental capacity. Some older adults may choose to deny themselves certain health or safety benefits, which may not be self-neglect. This may simply be their personal choice. Caregivers and other responsible individuals should respect these choices if the older person is mentally sound. In other cases, older adults may lack the necessary resources, due to poverty, or another social condition. This is also not considered “self-neglect.” Institutional abuse refers to physical or psychological harm, as well as violations of rights, in settings where care and assistance are provided to dependent or other older adults, such as nursing homes. Recent studies of nearly 2,000 residents of nursing home facilities in the United States reported a 44 percent increased rate of abuse and a 95 percent increased rate of neglect, making elder abuse in nursing homes an increasing risk. Accurate statistics are scarce because elder abuse in general and especially nursing homes are often a silent phenomenon. The key to preventing abuse and intervening to stop elder abuse is to be able to recognize the warning signs. Signs of elder abuse vary depending on the type of abuse the victim is experiencing. Each type of abuse has distinct signs associated with it. In addition to noticing signs in the elderly individual, abuse can also be detected by observing changes in the caregiver’s behavior. For example, the caregiver may not allow them to talk to or greet visitors, show indifference or lack of affection toward the elderly, or refer to the elderly person as a burden. Caregivers who have a history of substance abuse or mental illness are more likely to commit elder abuse than other individuals. Abuse can sometimes be subtle and therefore difficult to detect. Regardless, awareness and research organizations advise taking any suspicion seriously and addressing it adequately and promptly.

Geriatric medicine

Elderly trauma refers to an accidental injury to an older person. The top three accidental deaths in older adults are falls, collisions, and burns. Severe declines in central nervous system function lead to loss of proprioception or sensory coordination, balance, and gross motor coordination, as well as reduced hand-eye coordination, reaction time, and unsteadiness in walking. These destructive changes are often accompanied by joint stiffness, which results in reduced range of motion of the head, neck, and extremities. Older adults also often take multiple medications to control multiple diseases and conditions. Side effects of some of these medications can lead to injury or worsen a previous injury; for example, someone taking blood-thinning medications may experience a cerebral hemorrhage if they sustain a minor head injury. These activities combined put older adults at greater risk for injuries and accidents. Both the incidence of accidents and falls and the severity of their complications increase with age. Virtually all organs in the body experience declines in function as they age. One example is the decline in circulatory function due to enlarged heart muscles. This can lead to pulmonary edema or heart failure. Brain atrophy accelerates around age 70, leading to a dramatic decrease in brain volume. Since the skull does not decrease in volume, there is a large space between the two, exposing older adults to a higher risk of brain hematomas after head injuries. Decreased brain volume can lead to decreased vision, hearing, and mental status. The elderly are the fastest growing demographic in developed countries. Although they are less likely to sustain injuries and accidents than children and young adults, the death rate from accidents and injuries is higher in older adults than in children and young adults. In the United States, this age group accounts for approximately 14% of all accidental injuries, the majority of which are due to falls.

Geriatric medicine

Eating for older people should take into account how people’s experiences and lives change as they age. That is, including conditions such as taste, diet and food choice. This primarily occurs when most people approach age 70 or older. Influencing variables can include: social and cultural environment; gender; personal habits; as well as physical and mental health. Scientific studies explain why people like or dislike certain foods. There is a lot of work and scientific research that goes into studying the variables that cause older people to change their diets. An example of such studies would be an experiment conducted by the Senior Nutrition Programme. To improve the quality of meal programmes, the European Neighbourhood Policy explored how food preferences differed by biological sex and ethnic group. A total of 2,024 ENP participants aged 60 or older were interviewed. The majority of participants were female, or served through group meal programmes, or meals served in community settings such as senior centres, churches or senior living communities. The overall impression of the meals was assessed for the top 13 food groups. After adjusting for other variables, older men had a greater preference for deli meats, meats, legumes, canned fruits, and ethnic foods than did women. Additionally, compared to African Americans, “Caucasians showed a higher preference for 9 of 13 food groups including pasta, meat, and fresh fruit. To improve the quality of the ENP and to increase older adults’ adherence to nutritional programs, food services require a strategic meal plan that seeks out and integrates the best foods for older adults.” There are multiple parts of an older person’s life that can influence their food preferences. Aspects such as environment, mental and physical health, and lifestyle choices all contribute to how a person decides what foods they like or dislike. An article on the effects of cognitive function in older adults states that “the nutritional status of older adults is related to their quality of life, ability to live independently, and risk of developing costly chronic diseases.” Well-being can be influenced by multiple socio-environmental factors, including access to healthy and affordable foods, food outlet locations, and nutritious restaurant choices. The Academy of Nutrition and Dietetics, the American Dietetic Association, and the Society for Nutrition Education have identified older adults’ access to a balanced diet as critical to preventing disease and promoting nutritional wellness so that quality of life and independence can be maintained throughout the aging process and excessive health care costs can be reduced. An individual’s environment and health can influence the foods they choose and prefer to eat. As people age, their bodies change. This includes their taste buds, their needs for certain vitamins and nutrients, and their desire for a variety of foods. In a study by the Monell Chemical Senses Center, five hundred young men and forty older adults participated. The young adults ranged in age from eighteen to thirty-five, and the older adults were sixty-five or older. There were more females than males in the study, but there were roughly equal proportions of males and females in both age groups. The study noted that younger women had stronger cravings for sweets than older women. They linked this difference in preference to the younger female test subjects’ shorter menstrual cycles and the fact that older women are no longer going through menopause. The study also determined that “ninety-one percent of cravings associated with a cycle occur in the second half of the cycle.” These physical changes could explain why someone who is older may not be getting the nutrition they need. As taste buds change with age, some foods may not be perceived as appetizing. For example, one study by Phyllis B. Grzegorszyk, Ph.D., suggests that as we age, our sense of taste for salty foods slowly disappears. When older adults in nursing homes eat frozen meals that are high in salt, they don’t enjoy them. This can lead to depression, anxiety, or suicidal thoughts. Not only are there differences in food preferences between ages, but also in biological sex. In a study conducted by the Nutrition Program in the Elderly, researchers explored male and female subjects’ preferences for 13 individual food groups. From this study, it was clear that older men “were more likely to prefer deli meats, meats, legumes, canned fruits, and ethnic foods than were females.” Another study conducted by the Monell Chemical Sensitivity Center concluded that females had a greater desire for sweets and chocolate than males. The results of the study confirmed that males had greater cravings or preferences for appetizers than for sweets. As people age, some people tend to avoid food and are unwilling to modify their diet due to oral health problems. Oral health problems, such as ill-fitting dentures or gum disease, are associated with significant differences in dietary quality, a measure of diet quality using a total of eight recommendations for food and nutrient consumption. From the National Academy of Sciences. Approaches to reducing food avoidance and encouraging dietary changes are urgently needed for people with eating difficulties due to oral health conditions, such as their inability to chew or eat food properly, as their health is greatly improved and their food preferences are greatly limited. A decline in physical health can lead to a deterioration in diet due to difficulties in preparing and eating food as a result of conditions such as arthritis. At the 2010 Healthy and Safe Eating in Aging conference sponsored by the Institute of Medicine, Dr. Catherine Tucker noted that older adults are less active and have a lower metabolism with a reduced need to eat. They also tend to have existing diseases and/or take medications that interfere with nutrient absorption. With changing nutritional requirements, one study developed a modified food pyramid for adults over the age of 70. The impact of certain diseases can also affect the quality of food in older adults, especially those in nursing homes. Often, when some suffer from Alzheimer’s disease, they do not receive the necessary care, and a decline in mental health is seen. It is a proven fact that those who have relationships with others live longer. When a person falls victim to such a mentally limiting disease, they can die earlier than they would have if they had not had the disease. This can be changed with proper care and a general sense of well-being, but when a person does not have the right nutrition and food choices, they will fall victim to this. As a result of certain mental health conditions and/or diseases - such as Alzheimer's - a person's food preferences may be affected. With some diseases, people tend to develop specific preferences or aversions to different types of food. For example, people with Alzheimer's experience many large and small changes as a result of their symptoms. One change identified by Suszynski in "How Dementia Tampers With Taste Buds" is the taste of the dementia patient's brain, which contains taste receptors. Since they do not experience flavor as they once did, people with dementia often change their eating habits and take on entirely new food preferences. In this study, the researchers found that these dementia patients had problems identifying flavors and appeared to lose the ability to remember tastes. Thus, leading to the theory that dementia caused patients to lose their knowledge of flavors. This in turn could lead to changes in eating behaviors. Psychological conditions can affect eating habits in older adults. For example, prolonged widowhood can affect nutrition. Depression in older adults is also associated with a risk of poor nutrition. Older adults can make different lifestyle choices about healthy eating. Food choices are often the result of personal beliefs and preferences. Other research has found that adults, regardless of age, tend to increase their fruit and vegetable consumption after being diagnosed with breast, prostate, or colorectal cancer. The environment can greatly influence food preferences in older adults. Those 75 and older tend to have limited mobility due to health conditions and rely on others to shop for and prepare food. Homebound older adults tend to receive one meal a day from communities that provide group meals, or meals served in community settings such as senior centers, churches, or senior living communities. These meal programs are encouraged to provide this meal to seniors at least five times a week. Access to transportation may also be less important, especially in rural areas where public transportation is scarce. However, the Iowa study failed to find problems with food shopping among seniors in open rural towns and cities, as those who do not rely on their own transportation rely on family, friends, and senior services. A separate study found little difference in urban areas with seniors who do not own a car. Aside from transportation, the type and quality of food available can also shape food choices if a person lives in a so-called “food desert.” The type of social network can also influence individuals’ choices in older individuals as well. For example, someone with a larger social network and lower economic status is more likely to be well-nourished than someone with a smaller social network and higher economic status. This means that it is important for our younger aging population to maintain social networks so that they can live longer and have more active lifestyles, especially when it comes to food.

Geriatric medicine

Normal-pressure hydrocephalus, also called symptomatic hydrocephalus, is a brain disorder caused by decreased absorption of cerebrospinal fluid. Typical symptoms include gait disturbances, urinary incontinence, and dementia or mental decline. It is difficult to diagnose because these symptoms are common to many other diseases. The usual treatment is to place a shunt to drain excess CSF to another part of the body. This treatment may reverse symptoms and restore normal function, may do so partially, or may not. The term normotensive comes from a paper published in 1965 before the development of intracranial pressure measurement techniques, and it is now recognized that the term normotensive in the name of this disease is a misnomer. There are two types of normotensive hydrocephalus: idiopathic and secondary. Secondary hydrocephalus can be the result of subarachnoid hemorrhage, head trauma, tumor, infection of the central nervous system, or complications of skull surgery. Normal pressure hydrocephalus is an increase in intracranial pressure due to the accumulation of cerebrospinal fluid in larger than normal quantities in the ventricles of the brain, causing ventricles to enlarge. The intracranial pressure gradually decreases but remains slightly elevated, with the CSF pressure reaching the upper limits of the normal range of 150 to 200 mm H2O. These patients do not usually have elevated intracranial pressure numbers, so they do not experience the classic symptoms of increased intracranial pressure such as headache, nausea, vomiting, or altered consciousness, although some studies have shown that they do have intermittent pressure increases. However, the enlarged ventricles compress the adjacent cortical tissue, causing myriad effects on the patient. The classic symptomatic triad was first described by Hakim and Adams in 1965. Normative hydrocephalus is often misdiagnosed as Parkinson's, Alzheimer's, or dementia, due to its chronic nature and nonspecific symptoms. Normotonic hydrocephalus presents with the classic triad of clinical findings of urinary incontinence, unsteady gait, and cognitive impairment. Gait disturbance is usually the initial and most prominent symptom of the triad and may be progressive, due to dilatation of the ventricular system, especially at the level of the lateral ventricles. This compresses the motor fibers that descend through the corticospinal tract to the lumbosacral spinal cord, causing them to be pulled upward. Unsteady gait can be classified as mild, characterized by ataxia, or severe in the early stages. This gait disturbance often presents as ataxia and loss of balance, especially when climbing stairs and sidewalks. Muscle weakness and fatigue in the legs may be part of the complaint, although examination shows no paralysis or ataxia. The patient usually uses something to help him walk steadily without ataxia as he moves from mild to marked. A wheeled crutch or quadrupedal crutch is an aid to this. The patient's gait in the marked stage shows a lack of foot clearance when walking or the patient drags the foot on the ground while walking, in addition to a decrease in walking speed. This pattern is commonly referred to as a magnetic gait, where the foot appears to be stuck to the surface on which it is walking, and the gait disturbance is the characteristic symptom of normotonic hydrocephalus. The gait may begin to mimic a parkinsonian gait, with short, shuffling steps, a hunched, forward-bending posture, but no stiffness or tremor. An increased tendency to fall backwards is also seen, and the patient may also use a wide-based gait to increase their base of support and thus their stability. In the very late stages, the patient may deteriorate from the inability to walk to the inability to stand, sit, rise from a chair, or roll over in bed. This advanced stage is referred to as "ataxia of standing and walking due to hydrocephalus." Cognitive dementia: Cognitive dementia usually predominates in the frontal lobe and is a subcortical type of dementia. It manifests as apathy, forgetfulness, rigidity, inattention, and a decrease in the speed of processing complex information. Disorders of processing acquired knowledge, reflecting loss of frontal lobe integrity. Memory disturbances are often a component of the overall problems and are the most prevalent in some cases, which may lead to misdiagnosis as Alzheimer's. However, in normotonic hydrocephalus there may be a marked contrast between memory impairment and intact or less affected cognition. Dementia Dementia is thought to result from traction of the frontal and myelinated fibers that run in the periventricular area. Urinary incontinence: This appears late in the disease and is found to be caused by spastic hyperreflexia, increased urgency associated with decreased inhibition of bladder contractions and detrusor muscle instability. In the most severe cases, bladder hyperreflexia is associated with loss of interest in urination due to severe cognitive damage to the frontal lobe. This is also known as frontal incontinence, where the patient is indifferent to his frequent urinary symptoms. Diagnosis of normotonic hydrocephalus is usually made initially by brain imaging, either CT or MRI, to detect any mass brain injury. This is followed by lumbar puncture and evaluation of the clinical response to removal of CSF. This may be followed by continuous lumbar drainage of CSF over 3-4 days. CT may show dilated ventricles without atrophy of the cerebral convolutions. MRI may show minimal degrees of migration of CSF surrounding the ventricles into the ependymium in the second/Flier time sequence. Radiography may not differentiate between clinically similar pathologies such as Alzheimer's dementia, vascular dementia, or Parkinson's dementia. After radiography, lumbar puncture is the first step in the diagnosis and the CSF opening pressure is carefully measured. In most cases, the pressure is usually above 155 mm H2O. Clinical improvement after removal of CSF has a high predictive value for the success of subsequent shunt placement. This is called a lumbar puncture or Miller Fisher test. Conversely, a negative test has very little diagnostic value, and many patients improve after shunt placement despite no improvement after CSF removal. A leak test is a test that may have higher sensitivity and specificity than a lumbar puncture but is not performed in most centers. Some centers consider the velocity of CSF egress to be a significant predictor of the success of hydrocephalus surgery. The velocity of egress can be determined by a leak test. This is not a test usually performed before shunt placement but may be useful in determining the likelihood of a patient improving after shunt placement. In some centers, an external lumbar puncture has been shown to have high sensitivity and specificity for the expected success of surgery. Patients with dementia who are dependent on home nursing care and whose only diagnosis of hydrocephalus is stress are likely to become independent once treated. To date, only one study has been able to assess the prevalence of normotonic hydrocephalus in both diagnosed and undiagnosed populations and has shown a prevalence of 9-14%. Patients with normotonic hydrocephalus may recover surgically by implanting a ventriculoperitoneal shunt to drain excess CSF into the abdomen where it is absorbed. Once the shunt is in place, the ventricles usually shrink within 3-4 days, regardless of the duration of hydrocephalus. Despite the reduction in ventricular swelling, only 21% of patients show significant improvement in symptoms. Patients most likely to show improvement are those with only mild or no gait disturbance, mild cognitive impairment, or mild cognitive impairment. A more recent study in 2004 found better results, concluding that if patients with normotonic hydrocephalus are correctly identified, shunt implantation will result in beneficial outcomes in 86% of patients, with 81% of patients experiencing gait disturbance, 70% of patients experiencing improvement in grip strength, or both. Note also that measurements in the diagnostic triad, cortical sulcus size, and periventricular flare are all related to outcome. However, other factors such as patient age, duration of symptoms, ventricular dilatation, and degree of dementia before surgery are also related to outcome. Recent population studies have estimated the prevalence of normotonic hydrocephalus to be about 0.5% in people over 65 years of age with an incidence of about 5.5 patients per 100,000 population per year. This is consistent with similar findings that although normotonic hydrocephalus can occur in both men and women of any age, it has been found to occur predominantly in the elderly and peak incidence in the sixth or seventh decade of life.

Geriatric medicine

It should not be confused with Lewy body dementia, an umbrella term that includes Parkinson's disease and dementia with Lewy bodies. Dementia with Lewy bodies (DLB) is a type of dementia characterized by changes in sleep, behavior, cognition, movement, and autonomic functions. Memory loss is not always an early symptom. The disease worsens over time and is usually diagnosed when cognitive decline interferes with normal daily functioning. Along with Parkinson's disease, dementia with Lewy bodies is one of two conditions that fall within the category of Lewy body dementia. It is a common form of dementia, but its prevalence is not precisely known and many cases go undiagnosed. The disease was first described by Kenji Kosaka in 1976. REM sleep behavior disorder—in which people lose the muscle paralysis that normally occurs during REM sleep and act out their dreams—is a key feature. REM sleep behavior disorder may appear years or decades before other symptoms. Other key features are visual hallucinations, marked fluctuations in attention or alertness, and tremors. Not all features must be present for a diagnosis. A definitive diagnosis usually requires an autopsy, but a presumptive diagnosis is made based on symptoms and tests that may include blood tests, neuropsychological tests, imaging, and sleep studies. Most people with dementia with Lewy bodies do not have affected family members, although dementia with Lewy bodies sometimes runs in families. The exact cause is unknown, but it involves widespread deposits of abnormal protein clumps that form in the nerve cells of the affected brain. Known as Lewy bodies — discovered by Friedrich Lewy in 1912 — and Lewy bands, these clumps affect the central nervous system and the autonomic nervous system. Heart function and some gastrointestinal functions, from chewing to defecation, may be affected. Constipation is the most common symptom. Low blood pressure upon standing may also be a symptom. Dementia with Lewy bodies also affects behavior; mood changes such as depression and apathy are common. Dementia with Lewy bodies usually begins after age 50, and people with the disease have an average life expectancy of about 8 years after diagnosis. There is no treatment or medication to stop the disease from progressing, and people in the later stages of dementia with Lewy bodies may not be able to care for themselves. Treatments aim to relieve some of the symptoms and reduce the burden on caregivers. Medications such as donepezil and rivastigmine are effective in improving cognition and overall functioning, and melatonin can be used for sleep-related symptoms. Antipsychotics are usually avoided, even for hallucinations. Because severe reactions occur in about half of people with dementia with Lewy bodies, their use can be fatal. Dealing with the many different symptoms is difficult, as it involves multiple disciplines and caregiver education. Dementia with Lewy bodies is a type of progressive, neurodegenerative dementia. That is, it is characterized by deterioration of the central nervous system that gets worse over time. Dementia with Lewy bodies is sometimes classified in other ways. It is one of two types of Lewy body dementia, along with Parkinson's disease. Atypical Parkinson's syndromes include dementia with Lewy bodies, along with other conditions. Finally, dementia with Lewy bodies is an encapsulated neuropathy, meaning it is characterized by abnormal deposits of the protein alpha-synuclein in the brain. Other neuropathies include Parkinson’s disease, multiple system atrophy, and other rare conditions. This type of dementia is characterized by cognitive impairment, recurrent visual hallucinations, REM sleep disturbances, and parkinsonism immediately after or after the dementia is diagnosed, according to Melissa Armstrong. People with dementia with Lewy bodies have a wide range of symptoms, and it is generally more complex than most other types of dementia. The disease affects different areas of the nervous system; the accumulation of alpha-synuclein deposits damages these areas, causing the diverse neurological manifestations of the disease. Dementia with Lewy bodies begins with a specific set of early signs and symptoms called the prodromal phase of the disease or pre-dementia. These signs and symptoms may appear 15 or more years before the onset of dementia. These symptoms include constipation and dizziness due to autonomic nervous system dysfunction, decreased sense of smell, visual hallucinations, and rapid eye movement (REM) sleep disorder. REM sleep disorder may appear years or decades before other symptoms. Early symptoms do not always include memory loss. The manifestations of dementia with Lewy bodies can be divided into core, essential, and supporting features. Dementia is the core feature and must be present for diagnosis, while essential and supporting features are additional evidence to support the diagnosis. Dementia is diagnosed after cognitive decline has progressed to a point where it interferes with normal daily activities or social or occupational functioning. Dementia is a core feature of dementia with Lewy bodies, but it does not always appear early on and tends to appear as the condition progresses. Core symptoms vary but typically include: disturbance of cognition, alertness, or attention, disturbance of REM sleep, one or more parkinsonian features, and recurrent visual hallucinations. These features are classified as core features based on the 2017 Fourth Consensus Report of the Dementia with Lewy Body Consortium. The report relied on high-quality evidence to support the quality of these disease manifestations. Cognitive dysfunction is the most common and characteristic feature of Lewy body dementia. Cognitive dysfunction associated with this type of dementia is distinguished from other types of dementia by the associated disturbance in attention and alertness. It is also characterized by its spontaneous onset and by a clear distinction between the worst and best cases, according to McKeith. These fluctuations vary in severity, frequency, and duration. Each episode lasts from seconds to weeks and is separated by normal intervals. Cognitive tests will not accurately reflect the severity of the disease when relatively normal intervals coincide with monthly medical appointments. The disease affects three areas of cognition: executive function, visuospatial function, and attentional control. Episodic cognitive dysfunction appears early in the course of the disease. People with dementia with Lewy bodies are easily distracted, have difficulty concentrating on tasks, or are described as absent-minded, and may experience periods of blurred consciousness, confusion, agitation, and incoherent speech. People with dementia with Lewy bodies have trouble coherent speech and may have changes in their ability to organize their thoughts throughout the day. Executive functions describe attention, behavior, memory, and the cognitive flexibility that helps with problem solving and planning. Executive function problems occur in activities that require planning and organization. Deficits may include poor performance, inability to follow a conversation, difficulty multitasking, and problems with driving—such as misjudging distances or getting lost. A person with dementia with Lewy bodies may have problems with wakefulness and sleep in addition to REM sleep disorder, and these problems can be severe. Sleep and wakefulness disorders include daytime sleepiness, drowsiness or naps lasting more than two hours a day, insomnia, periodic limb movement disorder, restless legs syndrome, and sleep apnea. REM sleep disorder is a sleep disorder. People with dementia with Lewy bodies lose the normal muscle paralysis during REM, which can cause them to act out movements they do in their dreams or make other unusual movements or sounds. About 80% of people with dementia with Lewy bodies have REM sleep disorder. Abnormal sleep behaviors may begin before cognitive decline is noticed, may appear decades before any other symptoms, and are often the first clinical sign of dementia with Lewy bodies and an early sign of synucleinopathy. Autopsy evidence of synucleinopathy in individuals with REM sleep disorder confirmed by electroencephalography shows 94–98% of individuals with REM sleep disorder, with dementia with Lewy bodies and Parkinson's disease being the most common, with approximately equal rates. People with REM sleep disorder are diagnosed with a neurodegenerative disorder within 10 years, and neurodegenerative manifestations may be delayed for up to 50 years after the diagnosis of the sleep disorder. REM sleep disorder may lessen over time. Some people with REM sleep disorder are unaware that they are acting out their dreams. REM sleep disorder behaviors may include screaming, laughing, crying, slurred speech, nonviolent hitting, violent punching, kicking, choking, and scratching. Reported behaviors are violent and often in the context of a chase or attack. People with REM sleep disorder may fall out of bed or injure themselves or their bed partner, which can cause bruising, fractures, or subdural hematomas. People often remember violent dreams and behaviors and report them or seek medical attention when an injury occurs. Therefore, selection and recall bias may explain the high frequency of violent behaviors reported in the context of REM sleep disorder. Parkinsonism is a clinical syndrome characterized by slowness of movement, rigidity, balance disturbance, and tremor. Parkinsonism is seen in dementia with Lewy bodies and several other conditions, including Parkinson's disease, Parkinsonian dementia, and others. Parkinsonism is diagnosed in more than 85% of people with dementia with Lewy bodies; these patients usually have one or more of the core features of the syndrome, but tremors at rest are less common. Motor symptoms may include parkinsonian gait, balance disturbance, falls, rigid facial expressions, and soft speech. Motor symptoms vary in their presentation, but are usually symmetrical. Patients with dementia with Lewy bodies may have only one of the parkinsonian features, and the severity may be less than in Parkinson's disease.

Geriatric medicine

Reminiscence therapy is a technique used to provide counseling and support to older adults, and is used in patients with brain damage who have symptoms of “Alzheimer’s disease and other forms of cognitive impairment.” A 2018 article from the American Association of Retired Persons focused on a separate project called Gleaner Town Square that looked at individuals who had symptoms of Alzheimer’s disease or other forms of dementia. The goal of the Gleaner project was to “photograph the years 1953 to 1961,” with participants going back in time and reminiscing about their lives between the ages of 10 and 30, the period when “our strongest memories are formed.” The American Psychiatric Association defines reminiscence therapy as “the use of life histories, written, oral, or both, to improve psychological well-being. It is often used in older adults.” This type of therapeutic intervention respects the individual’s life and experiences and helps the patient maintain mental health. Most research on reminiscence therapy has been conducted in older adults, particularly those suffering from depression, though some studies have looked at other older populations. Reminiscence therapy has been researched and implemented in many areas across cultures, in Japan, the United Kingdom, and the United States. Reminiscence is described as “the process of voluntarily or involuntarily bringing to mind one’s past memories.” It involves reliving and reliving events in one’s life. This requires that “autobiographical memory” be intact in order to be able to recall specific life events. Reminiscence is meaningful to the extent that the memories retrieved are meaningful. There are different ways to make memories meaningful, including asking questions that suggest the significance of the event as well as using old memories from the past. Reminiscence has different psychological functions. Webster’s classification offers eight reasons why people reminisce: to relieve boredom, to revive emotional pain, to prepare for death, to have conversations and identity, to maintain intimate relationships, to solve problems, to teach, and to inform. Psychologists believe that the therapeutic use of reminiscence has positive results in improving coping skills and emotions, although its effectiveness is controversial. Recent data suggest that there are positive and lasting effects of reminiscence therapy among older people. There are different types of reminiscence. The two main types are interpersonal reminiscence and interpersonal reminiscence. Interpersonal reminiscence is cognitive in nature and is conducted individually. Interpersonal reminiscence is more conversational and is a group therapy. Reminiscence can be divided into three types: informative, evaluative, and urgent. Informative reminiscence is for the pleasure of retelling past stories. This type can be used to help people who have lost interest in life and relationships. Recalling good memories helps them focus on what they were happy about. Evaluative reminiscence is the main type used in reminiscence therapy because it is based on the “life review” introduced by Dr. Robert Butler. This process involves retrieving memories from across one’s life and sharing stories with other people. This is often done in group therapy. Urgent reminiscence is when an individual needs to let go of persistent emotional distress or guilt. By working through these issues, individuals can find peace with themselves. Reminiscence is used to help people cope with the death of a loved one by sharing stories about their life, remembering fond memories, and coming to terms with death. Reminiscence therapy is often used in nursing homes. The structure of reminiscence therapy can vary widely. In one documented session, the therapist played different songs from the 1920s to the 1960s and asked patients which songs held special meaning for them. In another session conducted by the same therapist, participants shared photos and talked about why they were important to them. Psychological research identifies two types of reminiscence therapy as particularly effective: integrative and procedural. Prior to the late 1950s, remembering the past was viewed as a negative symptom that often led to a decline in mental functioning. Erik Erikson introduced his concept of eight stages of psychological development from birth to death. The final stage is known as “late adulthood,” and it introduces the idea of “integration versus despair.” It is important at this stage to look back on one’s life with satisfaction and contentment before one dies. In 1963, Dr. Robert Butler published a paper on the critical points regarding the importance of life review and reminiscence. Butler is credited with starting the reminiscence therapy movement. Charles Lewis took the next step in the field in 1971. He conducted the first experimental study of reminiscence. Lewis wanted to investigate the cognitive changes that the process of remembering the past might cause, and how individuals viewed themselves. This experiment proved to be important, and in the years that followed it became a popular area of research. Subsequent research focused on the functions and benefits of remembering the past. In 1978, the U.S. Department of Health and Social Security began a project called the “Reminiscence Assistance Project.” The goal of the project was to begin using reminiscence as a therapeutic method. In the 1980s, reminiscence therapy was recognized by health care institutions and began to be used as a group therapy. During this time, the number of professionals trained to provide this therapy increased. Reminiscence therapy remains a research area to this day. Although much research has been done in this area, Butler and Erickson remain the researchers most closely associated with it.

Geriatric medicine

Home care or in-home care is supportive care provided in the home. Care may be provided by health care professionals who provide health care or by caregivers who provide day-to-day care and ensure that daily activities are maintained. Home care is often called "home health care" or primary care. The term home health care is often used to distinguish non-medical care from foster care and special care provided by people other than nurses, doctors, or licensed medical professionals. Home care services help adults, seniors, and children recover from hospitalization or need extra help to ensure their safety at home and avoid unnecessary hospitalizations. Home care is mostly made up of licensed and unlicensed non-medical staff who assist the patient with caregiving tasks. There are also unlicensed staff who help individuals with daily tasks such as eating, bathing, cleaning the house, and preparing meals. Caregivers work to meet the needs of individuals in need and this care helps them stay in their own homes rather than in a health care facility. Non-medical home care is paid for by the individual in need or a relative. The term “private duty” refers to the out-of-pocket nature of these services, as opposed to government- or insurance-sponsored health care. These traditional differences in home care are changing as the world’s population ages, so individuals are increasingly choosing to be independent and using these services to maintain their lifestyles. Government agencies and insurance companies are increasingly subsidizing these services instead of health care facilities because they are less expensive in the long run. Specialties associated with home care include licensed nurses, registered nurses, home health aides, physical therapists, occupational therapists, and social workers. Rehabilitation services are provided by physical therapists, occupational therapists, speech and hearing pathologists, and dietitians. Professionals may work as independent practitioners, as part of a larger organization, or as part of a branch. Licensed nurse aides and caregivers are trained to provide non-medical or non-custodial care, such as helping patients get dressed, get up, go to bed, and use the bathroom. They may also prepare meals, accompany patients to medical visits, go to the grocery store, and perform a variety of errands. The terms "home care" and "in-home care" are used interchangeably in the United States to mean any type of care provided to a person in their home. These terms have historically been used interchangeably to refer to caregivers who do not have the necessary skills to do so. However, there has recently been a movement to differentiate between in-home care providers, which are licensed nurses, and home care providers, meaning non-medical care. Home care aims to make it possible for people to stay at home rather than in long-term housing or health care institutions. Caregivers provide services to patients in their own homes. These services can be a combination of professional health care services and assisted living services. Professional home health services can include medical or psychological assessment, wound care, medication education, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Assisted living services include assistance with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral part of the recovery period after treatment, especially in the first few weeks when the patient needs the most daily assistance. Although there are differences in the terminology used to describe home care or home medical care in the United States and around the world, the description is similar for most parts. In the United States, it is estimated that most home care is informal, with family and friends providing the substantial amount of care. Health care professionals are most often associated with nurses, physical therapists, and home health aides in formal care. Other care providers include respiratory therapists, occupational therapists, and mental health therapists. Home health care is usually paid for through Medicaid, Medicare, long-term insurance, or the patient's own resources. Home health care applications or home care applications fall under the umbrella category of health care information technology. Home health information technology is "information processing applications including mechanical, electronic, and computer system software that store, retrieve, and share input information and use health care information and knowledge for communication and decision-making." Requirements are determined by each state's health department. Candidates for care are tested to become legally eligible for the title of "nursing aide." Other requirements in the United States include general background checks, drug and alcohol safety checks, and a background check. California does not provide licensing for non-health care services, so there are no requirements for admission. Full-service agencies conduct background checks of applicants, including criminal background checks. In addition, mediation agencies are trained to monitor and supervise home care providers. California licenses home care businesses under the California Home Health Administration. Florida licenses at several levels that relate to the services provided. Home aide agencies provide assistance to home care providers, although nursing and daily activities services are provided by home health agencies or nursing homes. Compensation varies by discipline, but Department of Labor statistics estimate that in 2012, home care providers were paid an hourly wage of $10.01 with an average annual wage of $20,820. A rule published by the Department of Labor titled “Application of Fair Labor Standards for Special Services” went into effect on January 1, 2015, and was written to revise “the definition of ‘attendant services’ to clarify and limit the duties that fall under the term; and third-party workers such as home care agencies will not be able to claim both exemptions.” The most significant effect of the recent law will be that more private-sector workers are protected from low wages, overtime, and record-keeping provisions for fair labor standards.” However, the Home Care Organization of America and a local home care organization sued the Department of Labor over the law being enforced in federal court. The Labor Department was subsequently appealed. The law was upheld in August 2015 by the U.S. District Court for the District of Columbia Circuit. $710,000 was paid by Medicare, if that is the primary carrier between the two types of insurance. Also, if a patient has Medicare and needs a skilled nurse practitioner, the patient’s case is often billed by Medicare. $235,000 is paid by private insurance or his/her own family. Private insurance includes the Veterans Administration and some health plans or private insurance for iron and steel workers. There are specialists and organized companies that provide home health care services. Lotus Shiu and Lee found that home nursing is better suited for patients with serious illnesses than for patients with non-critical conditions. Modin and Verhoeff stated that the role of physicians is more important than that of nurses and care workers. From an epidemiological point of view, the risk of infectious diseases acquired by home nursing is higher than that of inpatient and home care nurses. In terms of financial expenditure, home nursing is more effective than inpatient and home care nurses. The quality angles of home nursing are reviewed by Riccio. Christensen and Grönvall examine the challenges and opportunities presented by technical communication. Although health workers provide care to mature people and family members, health workers advocate appreciation for the mutual effort.

Geriatric medicine

Fall prevention is a set of actions that help reduce the number of falls suffered by older adults. Fall-related injuries are one of the most serious health problems in older adults. About one-third of older adults suffer from falls at least once a year. Half of them suffer from more than one fall a year. Due to osteoporosis, decreased mobility, and slowed reflexes, falls cause fractures of the pelvis and head, and sometimes cause death in these older adults. Fractures resulting from accidents are the fifth leading cause of death in older adults. In about 75% of fracture cases, patients suffer from incomplete recovery and general deterioration in health. Indicators of risk of falling include a history of a fall in the past, and problems with walking and balance. Some studies consider the following conditions to be associated with an increased risk of falling: impaired vision, certain medications, and deterioration in daily living activities and cognition. The role of orthostatic hypotension in increasing the risk of falling is unclear. Research indicates that intervention programs that reduce the risk factors for falls in adults reduce falls by 27 percent in the general population and by 14 percent in patients with a history of falls or other risk factors. This information is based on scientific studies conducted in this area. Although more research is needed, preventive measures that have shown the greatest impact in preventing falls include: balance, reducing household hazards, drug withdrawal effects resulting from stopping psychotropic medications, pacemakers, patients with carotid artery hypersensitivity, and Tai Chi. Tai Chi has shown a 47 percent reduction in falls in some studies, but it is not an aid to stability when standing. Tai Chi may help increase self-confidence rather than directly affecting balance when standing. Assistive technology can be implemented, although it may lead to reactions in cases of falls. Preventive improvements include handles that help with balance in the home and outside. It is advisable to have such bars next to the stairs and on the floors and when the floors have dangerous patterns such as slippery and unclear ones. There are special handles that can be placed in the bathrooms. In addition to crutches and supports that will facilitate movement and reduce falls. The lighting factor is important in human engineering in order to reduce the risks resulting from falling due to obstacles and dangerous places. The lamps must be available with high power and efficiency in places where there is danger in order to avoid it. These lamps must be fast in working and not the type that works late. This emphasis on the importance of adequate lighting comes because patients with macular degeneration and cataracts find it difficult to see. The stability factor while standing is also very important and for this reason it is recommended that the floors be as rough as possible to avoid slipping. In addition to wearing suitable shoes for this purpose, for example, shoes made of rubber and synthetic rubber. Padded floors such as carpets padded with foam and rubber may help to mitigate the damage caused by falls. Rubber tiles and covering and smoothing furniture with sharp corners can help. The risk of slipping increases when there are slippery rugs, banana peels, or spilled liquids on the floor. Floors should be free of obstructions. Bifocal and trifocal glasses used for reading only are not safe for walking and moving around while wearing them. It is recommended to wear separate glasses for reading and walking. The goal of health care is to identify the causes of falls and fractures, such as osteoporosis, multiple medications, balance and mobility problems, vision loss, and a history of falling. There are medications that are not recommended for use in older adults, which Pierre listed in his name. The evaluation of each patient's fall is aimed at identifying the causes and how to avoid them in the future. Some clinical tests are performed when the fall is not due to loss of consciousness in order to identify the causative factors. Studies have shown that strengthening flexibility, balance, and stability in patients improves movement and also prevents falls. The majority of older adults do not exercise regularly, and 35% of those over the age of 65 do not participate in recreational activities. Many people who have fallen stop exercising for fear of falling. The home can be a source of danger, especially the bathroom, shower and stairs. Home improvements can be made to reduce the risks surrounding the elderly patient, such as reducing clutter and increasing handles in necessary places such as the shower and next to the toilet. Installing anti-slip mats on the floor, providing iron bars next to the stairs, and adequate lighting can also help. Currently, there is no scientific evidence that these home improvements are effective in reducing risks. We have shown that these improvements. Falls are common in the age group of 65 years and older. The risk of falling is doubled when the person is hospitalized. The differences between falls in patients have not been determined in studies. The study says that 60% of elderly people with cognitive and memory problems suffer from falls each year. Most falls are due to patients with chronic health problems and are over the age of 65. Internal and external factors have been discovered to cause falls. In order to prevent falls, we must find solutions to the causes that lead to falls and try to find the necessary alternatives.

Geriatric medicine

Osteolysis is the active breakdown of the bone matrix by osteoclasts during the normal formation of healthy bone. Osteolysis can be thought of as a reversible process of bone formation. This breakdown usually occurs in the proximal portion of the prosthesis due to either an immune response or changes in the structural load of the bone. Diseases such as bone tumors, cysts, and chronic inflammation can cause osteolysis. Although osteolysis is often associated with a variety of diseases or joint problems, the term "osteolysis" generally refers to a common problem in artificial joint replacements such as total hip replacements, total knee replacements, and total shoulder replacements. Osteolysis can also be associated with radiographic changes seen in a person with biphosphate-related osteonecrosis of the jaw. There are several biological mechanisms that may lead to osteolysis. In total hip replacements, the generally accepted explanation for osteolysis involves wear particles. As the body attempts to clean these particles, it causes an autoimmune reaction that in turn leads to soft tissue damage. Osteolysis can occur as early as 12 months after implantation and is often progressive. This may require revision surgery. Although clinically asymptomatic, osteolysis can result in implant loss or bone fractures, which can lead to serious medical problems. Distal clavicle dissection is often associated with weightlifters' problems with the acromioclavicular joints resulting from the high stresses placed on the clavicle at its junction with the acromion. This condition is often referred to as "weightlifter's shoulder." Ultrasonography readily depicts resorption of the distal clavicle as irregular cortical erosions, whereas the acromion remains intact. Associated findings include a swollen joint capsule, soft tissue swelling, and joint instability. On physical examination, the joint is tender and the adduction maneuver toward the horizontal axis is painful. The acromioclavicular joint is usually stable but may have a crackling sound. The range of motion of the glenohumeral joint should be complete. The differential diagnosis may include metabolic, 1. autoimmune, and 2. malignant causes. Since distal clavicle degeneration usually involves a single joint, the presence of inflammation suggests that both joints are involved. Patients who fail conservative treatment are first restricted in their activities and may be considered for surgical treatment. Surgery is generally avoided in cases where surgery is contraindicated. Most operations are performed under general anesthesia, so nonsurgical treatment is continued for those patients who may be at risk from anesthesia. A common surgical procedure for distal clavicle degeneration involves resection of the distal portion of the clavicle and then removal of a few millimeters of bone from the distal end. Medications may be given to relieve pain and inflammation, and medications may be used to help the body form new bone cells more quickly. Follow-up with your doctor should be done if you feel that the medication is not working or if you experience side effects. He should also be informed in case of any allergy to any medication and keep a list of all medications, vitamins and herbs that are taken with the doses, and keep it with the patient at all times for emergencies. Exercise with caution and know the types of sports that can be practiced, as sports that require physical contact increase the chance of bone fractures. You should contact your doctor in case of: 8 Feeling pain in the chest, back, hip, groin, knee or foot with sudden movement or during rest. You should go to the emergency room in case of:

Geriatric medicine

Parkinsonism is a chronic neurological disorder characterized primarily by muscle stiffness. Parkinsonism is sometimes referred to as Parkinson's disease. Parkinsonism includes rigidity, tremor, slowness of movement, and impaired balance in posture. The name comes from Parkinson's disease, which is characterized by these symptoms. Parkinsonism can also be found in conditions other than Parkinson's disease, such as Lewy body dementia and Parkinson's disease dementia. Parkinsonism is a clinical syndrome characterized in Parkinson's disease by four motor symptoms: tremor, slowness of movement, contracture, and postural instability. Parkinsonian gait problems can lead to falls, and serious physical injuries are other common symptoms:

Geriatric medicine

The All-Inclusive Senior Care Program is a program that provides comprehensive health services to individuals age 55 and older who are frail enough to be classified as “home-care eligible” by their state’s Medicaid program. Services include primary and special health care, nursing, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor home modifications to accommodate the disabled, and anything else the program determines is medically necessary to improve the health of the member. PACE programs are designed to provide health care and directly employ a comprehensive group of health care workers to care for frail seniors—they are paid a fixed monthly fee per member and, in exchange, are responsible for providing all health services, sometimes including transportation. Because only the most severely frail and incapacitated are enrolled in PACE programs, they are precisely the patient population for whom prevention and health care will make a real difference. Most PACE patients receive multiple diagnoses, with an average of more than seven diagnoses per member. Among the most common diagnoses are heart problems, diabetes, hypertension, and vascular disease. PACE programs have strong incentives to help keep their members as healthy as possible—patients enrolled in these programs, if left unattended, are likely to require extensive nursing home care, which is very expensive. PACE programs therefore tend to provide high levels of preventive services, such as very frequent checkups, exercise programs, nutritional monitoring, strength and balance programs, etc. PACE programs also organize their services into “PACE Centers.” These centers tend to have a day health center, doctors’ offices, nursing, social services, rehabilitation services, and administrative staff, all in one location. Members’ visits to these centers are determined by their care plans. Care is planned with the member, his or her care team, and appropriate family members; most members attend two days a week. PACE was developed by OnLook Premium Health Services, a nonprofit organization that originated in the early 1970s in San Francisco’s North Beach Chinatown neighborhood. With research and administrative funding from the federal Administration on Aging, OnLock opened a day health center in 1972, modeled after the British Day Hospital Program. In 1978, they expanded this model to include full health care and social support for the frail elderly, and in 1979 they obtained federal waivers that allowed reimbursement for all outpatient and health-related services. In 1980, inpatient services were added, including skilled nursing care and hospitalization for acute illness. Amendments to the Social Security Act in 1983 gave OnLock authority to test a risk-based financing system that would include Medicare, Medicaid, and private pay. Major grants from the Robert Wood Johnson Foundation, the John Augustine Hartford Foundation, and the Retirement Research Foundation ensured that research and development activities could be established to support this model program. Congress extended OnLock’s waivers indefinitely, and provided waivers for similar programs at 10 sites. This support enabled OnLook to provide technical assistance to help new sites create and develop a cross-site database to track performance. In 1990, the first such sites received Medicaid and waivers as model programs, and this model became known as the All-Inclusive Senior Care Program, or PACE. The Balanced Budget Act of 1997 made PACE programs a permanent part of the Medicare program and an option under state Medicaid programs. The current PACE model programs became PACE providers by 2003. The Deficit Reduction Act of 2005 authorized the Rural PACE Initiative, and in 2006 the Centers for Medicare and Medicaid Services announced 15 rural PACE grantees. As of August 2010, 76 PACE programs and 5 pre-PACE programs operated in 30 states. The largest of these programs had more than 2,500 frail seniors enrolled, but most served a few hundred on average.

Geriatric medicine

Geriatric care management is the process of planning and coordinating care for the elderly and others with physical and/or mental disabilities to meet their long-term care needs, improve their quality of life, and maintain their independence for as long as possible. It involves working with older people and their families to manage, deliver, and refer a variety of health and social care services. Geriatric care managers accomplish this by combining a working knowledge of health, psychology, human development, family dynamics, public and private resources, and funding sources with advocacy for their clients throughout the continuum of care. For example, they may assist families of older adults and others with chronic needs such as those with Alzheimer’s disease or other types of dementia. Geriatric care management integrates health and psychological care with other needed services such as housing, home care services, nutrition services, assistance with activities of daily living, and socialization programs, as well as financial and legal planning. A care plan tailored to the specific circumstances is developed after a comprehensive assessment, and is continually monitored and modified as needed. A comprehensive geriatric assessment is an in-depth, comprehensive/complete evaluation that can take anywhere from 2 to 5 hours, and is divided into two or three assessment visits with the patient and family members. The comprehensive assessment is actually a series of smaller individual assessments, beginning with an initial assessment that includes demographic data as well as health history, social history, and legal/financial history. It then assesses the medication profile, as well as assessing ADLs and IADLs. Other assessments may include a fall risk assessment, home safety assessment, nutritional assessment, depression assessment, pain assessment, mini-mental status examination, mini-clock drawing test, balance assessment, and gait assessment. If the comprehensive geriatric assessment is performed by a registered nurse, a physical assessment may be included, such as vital signs such as temperature, pulse, respiration, blood pressure, oxygen saturation, and sometimes diabetes tests such as FBS or RBS. Physical assessments are also performed in areas such as cardiopulmonary, gastrointestinal, musculoskeletal, genitourinary, eye, ear, nose and throat, lower extremity examination, modified neurological assessment and medication compliance assessment. Geriatric care managers typically have prior training in nursing, social work, geriatrics or other health services fields. They are expected to have extensive knowledge of the costs, quality and availability of services in their communities. In some countries and jurisdictions, they may be certified by various professional associations, such as the National Association of Professional Geriatric Care Managers in the United States. Professional care managers help individuals, families and other caregivers adapt to and meet the challenges of aging or disability by:

Geriatric medicine

Lumbar spinal stenosis is a medical condition in which the spinal canal narrows, compressing nerves and blood vessels at the level of the lumbar vertebrae. Spinal canal stenosis can also affect the cervical or thoracic vertebrae, and these conditions are known as cervical spinal stenosis or thoracic spinal stenosis. Lumbar spinal stenosis can cause pain or abnormal sensations in the lower back or buttocks, loss of sensation in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control. The exact cause of lumbar spinal stenosis is not clear. Narrowing of spinal structures such as the spinal canal, lateral cavities, or intervertebral foramen is present, but is not sufficient to cause lumbar spinal stenosis alone. Many people who have an MRI have these changes but do not have symptoms. These changes are usually seen in people with degenerative spinal disease that occurs with aging. Lumbar spinal stenosis may also be caused by osteoporosis, osteophytes, tumors, trauma, or skeletal dysplasia such as dysplasia malformans and chondrodysplasia. Specialists diagnose lumbar spinal stenosis using a clinical history, physical examination, and CT or MRI. Electromyography may be helpful if the diagnosis is unclear. Age and widespread pain that worsens with prolonged standing or walking and is relieved by sitting, lying down, bending forward at the waist, and walking with long strides are helpful signs that may include: focal weakness or decreased sensation in the legs, decreased reflexes in the lower extremities, and difficulty with balance. All of the above signs are strongly associated with lumbar spinal stenosis. Most people with lumbar spinal stenosis are candidates for initial conservative, nonsurgical treatment. Nonsurgical treatments include medications, physical therapy, and injections. Surgery may slightly improve outcomes but carries more risks than conservative treatment. Overall, there is limited evidence to support the choice of surgical or nonsurgical treatment for people with symptoms of lumbar spinal stenosis. Similarly, evidence to support the use of acupuncture is also limited. Lumbar spinal stenosis is a common condition that causes significant morbidity and disability. It is the most common reason for spinal surgery in people older than 65 years. The condition affects more than 200,000 people in the United States. Understanding the meaning of the signs and symptoms of lumbar stenosis requires understanding what the syndrome is and how common it is. A recent review of lumbar spinal stenosis in the Journal of the American Medical Association Clinical Review Series confirmed that the syndrome can be considered when lower extremity pain occurs with back pain. The syndrome occurs in 12% of community-dwelling elderly men and up to 21% of retired men. The symptoms of lumbar spinal stenosis are similar to those of vascular claudication, which is why the term pseudoclaudication is used to describe the symptoms of lumbar spinal stenosis. These symptoms include pain, weakness, and tingling in the legs, which may radiate to the feet. Additional symptoms in the legs may include fatigue, heaviness, weakness, tingling, numbness, or cramping, in addition to bladder symptoms. Symptoms are most often symmetrical and bilateral, but may be unilateral. Leg pain is usually more bothersome than back pain. Pseudoclaudication, now referred to as neurogenic claudication, worsens with standing or walking, improves with sitting, and is often associated with postures that stretch the lumbar cord. Lying on the side is more comfortable than lying on the back, as it allows for greater lumbar flexion. Vascular claudication may mimic those of neurogenic claudication, with some individuals experiencing unilateral or bilateral symptoms that radiate to the legs, rather than the classic symptoms of true claudication. The first symptoms of stenosis include episodes of low back pain. After a few months or years, this may progress to claudication. The pain may be radiating, following classic neural pathways. This occurs as the spinal nerves or spinal cord become increasingly trapped in a smaller space within the canal. It is difficult to tell whether pain in older adults is caused by reduced blood flow or narrowing, but tests can distinguish between the two. However, some patients may have both conditions. In people with lower extremity pain and back pain, lumbar stenosis is twice as likely to be the cause in those over 70 years of age, and less than half as likely in those under 60 years of age. Characteristics of the pain are also helpful in diagnosis. When discomfort does not occur while sitting, lumbar spinal stenosis is significantly more likely, about 7.4 times more likely. Other features that increase the likelihood of lumbar spinal stenosis include: symptoms improve when bending forward, pain that occurs in either the buttocks or legs, and the presence of neurogenic claudication. On the other hand, the absence of neurogenic claudication makes lumbar stenosis less likely to explain the pain. Nonsurgical treatments and laminectomy are the standard treatment for lumbar spinal stenosis, and conservative treatment is usually recommended. Individuals are generally advised to avoid stress on the lower back, especially during spinal extension. Physical therapy programs that strengthen the core and provide aerobic exercise may be recommended. There is no conclusive scientific evidence on whether conservative or surgical treatment is better for lumbar spinal stenosis. Evidence for the use of pharmacologic interventions in the treatment of lumbar spinal stenosis is weak. Injectable calcitonin, rather than intranasally, may be helpful for short-term pain relief. Epidural injections may also provide temporary pain relief, but there is no evidence of long-term benefit. Adding corticosteroids to these injections does not improve outcomes, and the use of epidural steroid injections is controversial and the evidence for their effectiveness is conflicting. Nonsteroidal anti-inflammatory drugs, muscle relaxants, and opioid analgesics are used to treat low back pain, but evidence of their effectiveness is limited. Surgery appears to be better if symptoms persist after 3–6 months of conservative treatment. Laminectomy is the most effective surgical treatment. Surgery improves 60–70% of cases where symptoms worsen despite conservative treatment. Another procedure used an interbody abduction device called X-Stop was less effective and more expensive when repairing multiple levels of the spine. Both surgeries are more expensive than medical treatment.

Geriatric medicine

Gerontology is the scientific study of the aging process. It is a multidisciplinary field that draws from the biological and psychological sciences. Geriatric medicine is the practice that focuses on the physiology, pathophysiology, diagnosis, and management of disorders and diseases of the elderly. Because aging is a natural process, the care of the elderly cannot be limited to a single specialty but rather through a collaborative effort. Geriatric nursing is a multidisciplinary approach to providing care that combines expertise and resources to provide comprehensive geriatric assessment and nursing interventions. Nurses collaborate with a medical team to provide appropriate services to patients and provide comprehensive care.

Geriatric medicine

Dementia with Lewy bodies, also known as Lewy body dementia or diffuse Lewy body disease, is a type of dementia that usually accompanies Parkinson's disease. Anatomically, it is characterized by the presence of Lewy bodies and alpha-synuclein and ubiquitin protein deposits in the nerves. These substances can be detected during a postmortem brain autopsy. Lewy body dementia is a progressive memory loss that primarily affects older adults. The characteristic feature of this disease is a gradual decline in cognitive ability, which leads to hallucinations and poor comprehension and attention to what is in the patient's surrounding environment compared to a healthy person. People with Lewy body disease show an inability to plan and think and varying changes in perception. The alertness of these patients varies from day to day, and their attention and short-term memory vary. Persistent or intermittent visual hallucinations accompanied by clear images and visions are early signs of this disease. The patient's sleep pattern can be disturbed, accompanied by vivid visions, recurring dreams, violent deliberate movements, and then falling out of bed. Lewy body disease overlaps medically with Alzheimer's and Parkinson's diseases, but it accompanies Parkinson's disease more. For this reason, when this disease was discovered in its early years, it was not diagnosed correctly. In Lewy disease, it was believed that the loss of acetylcholine-producing neurons was the cause of the decline in cognitive function - which is somewhat similar to Alzheimer's - while the loss of dopamine-producing neurons was responsible for the gradual loss of control over voluntary functions - which is similar to Parkinson's disease - so this disease resembles both of the previous diseases. Therefore, the overlap between these three diseases makes the diagnosis of Lewy body disease more difficult, so that it can sometimes be confused with the early symptoms of Alzheimer's disease and vascular dementia. However, it is possible to distinguish between Alzheimer's, which develops slowly, and Lewy body disease, which develops and begins suddenly and rapidly, especially in the first months of the disease. Although it is difficult to identify and identify this disease, an accurate diagnosis is necessary to avoid the greatest number of side effects of antipsychotic drugs and thus provide treatment that can improve the life of the person with Lewy body disease and the people around him. The use of medications containing benzodiazepines, antidepressants, anticholinergics, and over-the-counter cold medications may lead to psychosis and hallucinations for a short period. The known dementia associated with Parkinson's disease and that associated with Lewy bodies can be distinguished by the time they appear with Parkinson's disease. In the first, dementia associated with Parkinson's disease is diagnosed when the dementia appears more than a year after Parkinson's disease has started. While dementia associated with Lewy bodies is diagnosed when the time of the patient's mental decline is known at the same time as the onset of Parkinson's disease symptoms or during the first year of its onset. Symptoms vary from person to person, but the core symptoms of the disease include changes in the level of cognition with large differences in the level of attention and comprehension from day to day and from hour to hour, varying episodes of hallucinations, and motor symptoms associated with Parkinson's disease. Other symptoms such as sleep disturbances and other signs can be detected by CT scan. Parkinson's disease symptoms associated with Lewy body dementia include a shuffling gait, decreased ability to control facial muscles, stiffness or rigidity when moving, a low voice level when speaking, thick saliva and difficulty swallowing. Involuntary body tremors in people with Lewy body disease are less common than in Parkinson's disease. People with this disease also have problems with postural hypotension, falls and frequent loss of consciousness. Sleep-disordered breathing can be a symptom of multiple system atrophy. A well-known and important medical sign of this disease is severe sensitivity to antipsychotic and antiemetic drugs that affect the nerves that produce acetylcholine and dopamine. This sensitivity can lead to complete paralysis, complete loss of consciousness or can expose him to a dangerous state of muscle rigidity. Therefore, these drugs should not be used or used with caution. Hallucinations that people with Lewy body disease often see people or animals that are not there, which may indicate the presence of Lewy bodies in the temporal lobe. Symptoms of psychosis include the feeling of being in two or more different places at once, etc. Hallucinations and psychoses can be disturbing, but not all of them are experienced as being pleasant or knowing that they are not real. Patients also suffer from visual disturbances, including double vision and misinterpreting what they are looking at, such as thinking that what they are looking at is a group of snakes when it is actually a pile of socks. The exact cause of Lewy body disease is not yet understood, but a link has been described to the gene PARK11. Like Alzheimer's and Parkinson's, Lewy body disease tends to run in generations, so its genetic link is not strong. However, like Alzheimer's, the risk of developing the disease increases when a person inherits the ε4 allele of apolipoprotein E. Pathophysiologically, Lewy body disease is characterized by deposits of Lewy body proteins in various parts of the brain. These deposits are known as Lewy bodies. These bodies are somewhat similar to the protein deposits under the cerebral cortex in Parkinson's disease. In addition, the neurons that produce both dopamine and acetylcholine are lost or destroyed, just as occurs in Parkinson's and Alzheimer's diseases, respectively. Also, the brain shrinks or shrinks in size as the cerebral cortex deteriorates. Postmortem examination of the brain showed epidemiological signs similar to Alzheimer's disease. The deposits of Lewy bodies that appeared in the cortex also appeared in Alzheimer's disease, but they were found deposited in the hippocampus, in addition to granular deposits in the space around the hippocampus. It is not yet known whether Lewy body disease is a type of Alzheimer's disease or a separate disease. Unlike Alzheimer's, Lewy body disease does not show any visible atrophy when the brain is examined. There is no cure for Lewy body disease. However, there is a medication that works to relieve the symptoms of this disease but does not help in its disappearance and is used as a pain reliever. We can divide the current treatment methods into drug therapy and care. Drug therapy is treated by balancing the treatment of the motor, emotional, and cognitive symptoms of this disease. Motor symptoms respond to the drug used to treat Parkinson's disease, and cognitive problems may improve with Alzheimer's medication. An estimated 60 to 75% of people diagnosed with dementia have either Alzheimer's disease or a combination of the two. 10 to 15% of dementia cases are due to Lewy body disease, with other types of dementia accounting for the last 15-20%, such as frontotemporal lobe atrophy known as Pick's disease, alcoholic dementia, and others. Lewy body disease affects men more than women. This disease affects about one million people in the United States alone. The protein deposits that cause this disease were first discovered by the scientist (Frederick Lewy) in the early eighteenth century. But the first person to describe the disease was the Japanese neuropsychologist in 1976. The diagnosis of Lewy body disease began in the mid-nineties after the discovery of the alpha-synuclein stain, which revealed Lewy bodies in the cerebral cortex during autopsies of patients who had dementia. The disease was not included in the Diagnostic and Statistical Manual of Mental Disorders, which was published in 1994, but it was briefly described in the 2000 edition of the manual under the name . In 1996, some scientists called for an amendment and then a revision of the diagnostic guidelines for this disease.

Geriatric medicine

The Lothian Birth Cohort studies comprise three cohort studies, combining research in psychology, epidemiology, and gerontology. The Lothian Birth Cohort of 1921 investigated childhood intelligence, at age 11, and health outcomes in old age. The study included a group of 551 adults born in the Lothian area of Scotland in 1921. The publications that resulted from this study contributed to the emerging field of cognitive epidemiology. One of the most important findings of this study was that children with higher IQs at age 11 were not better protected against cognitive decline in later life. Instead, they had better cognitive ability in old age, attributable to greater stability in intelligence across their lives. The 1936 Lothian Birth Cohort Study is a similar cohort to the 1921 study, but includes 1091 participants born in 1936. The sample size was larger than the 1921 cohort, and more detailed information was collected on those born in 1936. Additional intelligence tests were administered to 1208 people born on the first day of the intercalary months of 1936, and detailed information on the home environment was provided. These additional data were collected annually for the following 16 years, and included home visits by the researcher. The Lothian Birth Cohort studies can provide information on the determinants of cognitive decline, because they have a measure of premorbid intelligence measured at age 11. They can also be used to provide information on health differences in old age, taking childhood factors into account. The 1921 Lothian Birth Cohort Study was funded by several UK research funding councils and other agencies. The 1936 Lothian Birth Cohort Study was funded by the charity Older People UK and the charity Help Older People, which has recently become part of the Unplugged Mind Project. The Lothian Birth Cohort Study is supervised by Professor Ian Derry in the Department of Psychology at the University of Edinburgh.

https://ar.wikipedia.org/wiki/%D8%AF%D9%86%D9%81

Geriatric medicine

Cachexia is weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite in a person who is not actively trying to lose weight. The official definition of cachexia is a loss of body mass, with minimal accumulation of adipose tissue, that cannot be reversed nutritionally: even if the person eats more calories, some of the body mass is lost, reflecting the presence of an underlying disease. Cachexia is seen in patients with cancer, AIDS, celiac disease, chronic obstructive pulmonary disease, multiple sclerosis, rheumatoid arthritis, congestive heart failure, tuberculosis, familial amyloid polyneuropathy, mercury poisoning, and hormonal imbalances. Cachexia is a well-established risk factor, meaning that if a patient has cachexia, the chance of dying from the underlying disease is greatly increased. Cachexia can be a clinical sign of various underlying disorders. When a patient with cachexia is seen by a doctor, he or she will generally consider the possibility of adverse drug interactions, cancer, metabolic acidosis, certain infectious diseases, chronic pancreatitis, and some autoimmune diseases. Cachexia weakens patients Physically to a state of immobility caused by loss of appetite, weakness, and anemia, and the response to standard therapy is usually poor. Cachexia includes sarcopenia as part of its disease course. Cachexia is usually seen in the final stages of cancer and is called cancer cachexia. Patients with congestive heart failure may suffer from wasting syndrome. Cachexia is also seen in patients with any of the group of diseases classified as chronic obstructive pulmonary disease. Cachexia is also associated with advanced stages of chronic kidney disease, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia, HIV, and progressive diseases. About 50% of all cancer patients suffer from cachexia. Those with pancreatic and upper gastrointestinal cancers have a higher incidence of developing cachexia symptoms. This figure rises to 80% in patients with terminal cancer. In addition to increased morbidity and mortality, worsening side effects of chemotherapy, and decreased quality of life, cachexia is a direct cause of death for a large proportion of cancer patients, ranging from 22% to 40% of patients. Symptoms of cachexia include progressive weight loss and depletion of host stores of adipose tissue and skeletal muscle. Cachexia should be suspected if 5% of precachexia weight is lost involuntarily within 6 months. Conventional treatment approaches, such as appetite stimulants, 5-HT3 antagonists, nutritional supplements, and COX-2 inhibitors, have not been shown to reverse the metabolic abnormalities in cachexia. The exact mechanism by which these diseases cause cachexia is not understood, but there may be a role for inflammatory cytokines, such as tumor necrosis factor-alpha, interferon-gamma, and interleukin-6, as well as tumor-secreted proteolytic factor. Syndromes associated with cachexia include kwashiorkor and marasmus, although these syndromes have no underlying cause and are often symptoms of severe malnutrition. Those with eating disorders such as anorexia nervosa have elevated levels of ghrelin in Plasma. Ghrelin levels are also elevated in patients with cancer-induced cachexia. Much research is currently focused on determining the mechanism of cachexia. The two main theories for the pathogenesis of cancer cachexia are: Although the mechanism by which cancer cachexia occurs is not understood, the involvement of biological pathways can be discerned, including pro-inflammatory cytokines such as tumor necrosis factor-alpha, neuroendocrine hormones, insulin-like factor 1, and tumor-specific factors such as protein degradation-inducing factor. Inflammatory cytokines involved in wasting diseases are interleukin-6, tumor necrosis factor-alpha, interleukin-1β, and interferon-gamma. Although many different tissues and cell types may be responsible for the increased cytokines in circulation in some cancers, evidence points to tumors as an important source. Cytokines are capable of weight loss. TNF-alpha has been shown to have a direct catabolic effect on skeletal muscle and adipose tissue and to cause muscle atrophy through a pathway Ubiquitin – a proteolytic proteasome. The mechanism involves the formation of reactive oxygen species that leads to increased expression of the transcription factor nuclear factor kappa light chain enhancer in activated B cells. NF-κB is a known regulator of genes encoding cytokine synthesis and cytokine receptors. Excess cytokine secretion stimulates proteolysis and breakdown of myofibrillar proteins. How cachexia is treated depends on the underlying cause, overall prognosis, and related factors related to the individual. Reversible causes, underlying diseases, and contributing factors are treated if feasible and acceptable. A growing body of evidence supports the efficacy of β-hydroxy β-methylbutyrate as a treatment to reduce, or even reverse, the loss of muscle mass, muscle function, and muscle strength that occurs in hypercatabolic conditions such as cachexia. Consequently, as of June 2016, it is recommended that prevention and treatment of cachexia include HMB supplementation, regular strength training, and high-protein diets. Progestins such as megestrol acetate are used as an option Treatment for intractable cachexia with anorexia as the main symptom. Cachexia now occurs less frequently in HIV/AIDS than in the past due to the advent of HAART. Combination therapy for cancer cachexia is recommended in Europe, as a combination of nutrition, medication, and non-drug therapy may be more effective than monotherapy. Non-drug therapies that have been shown to be effective in cancers caused by cachexia include nutritional counseling, psychotherapeutic interventions, and physical training. Anabolic androgenic steroids such as oxandrolone may be helpful in cancer cachexia but are recommended for use for a maximum of two weeks; Longer treatment times increase the burden of side effects. Other medications that have been used or are being investigated for the treatment of cachexia, but conclusive evidence of efficacy or safety is lacking, and are generally not recommended: Medical marijuana is legal for the treatment of cachexia in some states, including Illinois, Maryland, Delaware, Nevada, Michigan, Washington, Oregon, California, Colorado, New Mexico, Arizona, Vermont, New Jersey, Rhode Island, Maine, New York, Hawaii, and Connecticut. There is insufficient evidence to support the use of oral fish oil for the treatment of cachexia associated with advanced cancer. There are limited options for treating cancer cachexia patients. The current strategy is to improve appetite using aphrodisiacs to ensure adequate nutrient intake. Pharmacological interventions using appetite stimulants, nutritional supplements, 5-HT3 antagonists, and COX-2 inhibitors have been used to treat cancer cachexia, but with limited effect. Studies have suggested that increasing calorie-dense calories and increasing protein intake can at least stabilize weight, although lean body mass did not improve in these studies. Treatment strategies are based on Inhibition of cytokine synthesis or action. Thalidomide has been shown to inhibit the production of TNF-α in mononuclear cells in vitro and to normalize TNF-α levels in vivo. A randomized, placebo-controlled trial in patients with cachexia cancer showed that it was well tolerated and effective in reducing weight loss and lean body mass in patients with advanced pancreatic cancer. Improvement in lean body mass and quality of life was also observed in a randomized, double-blind trial of a protein- and calorie-dense, omega-3 fatty acid supplement, provided that its consumption was equal to or greater than 2.2 g eicosapentaenoic acid (EPA) per day. It also works by reducing TNF-α production. However, data from a large, double-blind, placebo-controlled, multicenter trial suggest that EPA alone is not successful in treating weight loss in patients with advanced gastrointestinal or lung cancer. Peripheral muscle protein degradation, as occurs in cancer Cachexia, mobilizes amino acids required for liver and tumor protein synthesis. Therefore, the administration of amino acids from an exogenous source theoretically acts as a metabolic fuel for protein conservation by providing substrates for muscle metabolism and gluconeogenesis. Studies have shown that dietary supplementation using a specific combination of high-protein, leucine and fish oil improves muscle function, daily activity and immune response in cachexia-bearing mice. In addition, the use of beta-hydroxy beta-methylbutyrate derived from leucine catabolism as a nutritional supplement in tumor-bearing mice prevents cachexia by modulating NF-κB gene expression. A phase II study involving the use of antioxidants, nutritional-pharmacologic support, progestins (megestrol acetate and medroxyprogesterone acetate), and cyclooxygenase-2 inhibitors, demonstrated efficacy and safety in the treatment of advanced cancer patients with cachexia in different locations. These data support the use of multi-step therapies in the treatment of cachexia cancer. New studies It is suggested that nonsteroidal anti-inflammatory drugs, such as sulindac, significantly reduced cachexia. Studies have also shown that branched-chain amino acids can revert the metabolism of cachexia patients from catabolic weight loss to anabolic muscle gain, in 55% of patients. Branched-chain amino acids are composed primarily of leucine and valine. A paper published in the Indian Journal of Palliative Care concluded that branched-chain amino acids interfere with the activity of serotonin in the brain and prevent the stimulation of critical muscle protein degradation pathways. The potential role of branched-chain amino acids as appetite suppressants and anti-wasting agents was suggested many years ago, but since then experimental studies and clinical trials have tested their ability to stimulate food intake and counteract muscle loss in anorexic and overweight patients. In experimental models of cancer cachexia, BCAAs were able to induce significant suppression of body weight loss, produce significant increases in skeletal muscle wet weight, and improve muscle performance and daily activities. The essential amino acid glutamine has been used as a component of oral supplements to reverse cachexia in patients with advanced cancer or HIV/AIDS. According to the 2007 AHRQ National Inpatient Sample, in 129,164 hospitals surveyed in the United States, cachexia was listed as at least one of 14 recorded diagnosis codes for 26,325 unweighted cases. A sample of 32,778 unweighted outpatients in the United States collected in the CDC National Ambulatory Care Survey did not list any cases in which cachexia was one of up to three recorded diagnoses during visits.

Geriatric medicine

Elderly care or hospice care is the provision of special needs and requirements for senior citizens. The term includes services such as assisted living, adult day care, long-term care, nursing homes, nursing home care, and home care. Because elder care is so widespread internationally, as well as culturally diverse views on senior citizens, it cannot be limited to a single practice. For example, many countries in Asia use government-sponsored elder care as a very rare practice, preferring traditional methods of caring for younger family members. Elderly care emphasizes the social and personal needs of senior citizens, who require some assistance with daily activities and health care, but who wish to age with dignity. It is an important distinction, in that the design of housing, services, activities, and staff training should be truly customer-focused. It is also worth noting that many elder care services around the world are voluntary and unpaid. The form of care provided to the elderly varies greatly between countries and is constantly changing. Even within a single country, religious differences are taken into account in elder care. However, it has been noted that The elderly around the world consume the most health expenditures of any age group, and the observation that comprehensive care for the elderly is perhaps very similar. One must also explain the large increase in the proportion of elderly people in the world, especially in developing countries; As the pressures of continued fertility are limiting and family size is decreasing. Traditionally, care for the elderly has been the responsibility of family members and has been provided through the extended family home. As modern societies have grown, care for the elderly has become more and more often provided by the state or charitable organizations. Reasons for this change include shrinking family size, increasing life expectancy for older people, geographic dispersion of families, and women entering education and working outside the home. Although these changes initially affected Europe and North America, they are now increasingly affecting countries in Asia as well. In most Western countries, elderly care facilities are residential family homes, self-contained assisted living facilities, nursing homes, and continuing care for retirees. A family home is a residential home with support staff and supervision by an agency, organization, or individual who provides room, board, personal care, and rehabilitation services in a family environment of at least two and no more than six people. According to the Family Care Alliance, most caregivers are women. “Many studies look at the role of women and families as caregivers. Although not Issues that address gender and caregiving specifically, the results are still generalizable” to be: - Estimates of the age of household or informal caregivers who are women range from 59% to 75%. - The average caregiver is 46 years old, female, married and working outside the home for an annual income of $35,000. - Although men also provide care, female caregivers may spend more than 50 percent of the time that male caregivers do. According to the U.S. Department of Health and Human Services, the senior population—those 65 years of age or older—numbered 39.6 million in 2009. They represented 12.9 percent of the U.S. population, about one in eight Americans. By 2030, they will number 72.1 million, double the number in 2000. People 65 and older represented 12.4 percent of the population in 2000, but that percentage is expected to increase to 19 percent by 2030. This means that the demand for senior living facilities will increase in the coming period. There were more than 36,000 assisted living facilities in the United States in 2009, according to the Assisted Living Federation of America in 2009. More than One million seniors were served by these assisted living facilities. Last year's spending in the United States represented 22 percent of total medical spending, 26 percent of total Medicare spending, 18 percent of total non-Medicare spending, and 25 percent of total Medicaid spending. In the United States, most large multi-facility providers are publicly owned and operated by for-profit businesses. There are exceptions. The largest in the United States is the Lutheran Good Samaritan Society, a nonprofit organization that operates 6,531 beds in 22 states, according to a 1995 study by the American Health Care Association. If given the opportunity; Most seniors would prefer to continue living in their homes. Many seniors gradually lose their ability to function and require either additional assistance at home or a transition to a nursing home. Adult children of seniors often face difficult challenges in helping their parents make the right decision. Assisted living is one option for seniors who want help with daily tasks. It costs less than nursing home care, but is still considered expensive for many people. Home care services may allow seniors to live longer in their homes. One relatively new service in the United States that can help seniors stay in their homes longer is respite care. This type of care gives caregivers the opportunity to go on a vacation or business trip and know that their elderly loved ones are receiving high-quality temporary care, since without such assistance the elderly would probably have to move permanently to an outside facility. Another unique type of care in American hospitals, called acute hospice care, provides a “family placement” within a medical center designed for seniors. For information about long-term care options in the United States, see: You can contact your local area agency on aging, or senior referral agencies such as Place for Mom. Additionally, the U.S. government rates health care facilities through websites that use aggregated data from sources such as Medicare. In Canada, there are also such facilities that are privately run and not for profit. Due to cost factors; Some provinces operate public facilities that are funded by the government and managed by the health department of each province or territory, or the government may subsidize the costs of these facilities. In these care homes, senior Canadians may pay for their care on a sliding scale, proportional to their annual income. Their payment range depends on whether the care is “long-term” or “assisted living.” For example, starting in January 2010, seniors living in government-subsidized “long-term care” in British Columbia will pay 80% of their after-tax income, unless their after-tax income is less than $16,500. The price of “assisted living” is simply 70% of their after-tax income. As we saw in Ontario, there were waiting lists for long-term care homes, however, families may need to resort to home health care, or pay for accommodation in a private retirement home. Aged care in Australia is designed to ensure that each Australian citizen contributes as much as possible to the cost of care, based on their individual income and assets. This means that residents only pay what they can afford. They can afford it, and the Commonwealth Government is paying what they can't. An Australian statutory body, the Productivity Commission, conducted a review of aged care that began in 2010 and reported in 2011. This review concluded that almost 80% of care for Australians aged was provided informally, by family, friends and neighbours. About a million people received government-subsidised aged care, most of whom received low-subsidised community care, with 160,000 people in permanent residential care. Aged care spending by all governments in 2009–10 was almost $11 billion. The need to increase the amount of care, and the recognition of weaknesses in the care system, led several reviews in the 2000s to conclude that Australia's aged care system was in need of reform. This culminated in the Productivity Commission's 2011 report and subsequent reform proposals. According to the Living Longer and Living Better amendments of 2009–10, 2013, Assistance was provided according to established care needs, with additional supplements for people experiencing homelessness, dementia, and veterans. Aged care for Australians is often complex due to different state and federal funding. Furthermore, there are many shortcuts that clients need to be aware of. Aged care in England is increasingly rationed according to a joint report by the King’s Fund and the Nuffield Trust. People are left to struggle on their own without support. Large numbers of older people need assistance as a result of ageing housing but are paid for less. Millions of people who need care find neither formal nor informal assistance. Due to health and economic benefits; life expectancy in Nepal has increased from 27 years in 1951 to 65 years in 2008. Most older Nepalis, around 85%, live in rural areas. Because of this; There is a significant lack of government-sponsored programs or nursing homes. Traditionally, parents live with their children, and today, it is assumed that 90% of the elderly live in their family homes. This number is changing as more and more children leave their homes for work or study, leading to loneliness and mental problems for the elderly Nepalis. The Ninth Five-Year Plan included policies to try to take care of the elderly left without their children as guardians. A health facility fund for the elderly has been established in each province. The implementation guide for the health facility program for the elderly, “2061BS” provides medical facilities for the elderly, and those suffering from poverty, with medical and health care in all provinces. The government has planned to fund free health care for all heart and kidney patients above 75 years of age. Unfortunately, many of these plans are difficult to achieve, as the Nepalese government has learned. Nepal is a developing country and cannot afford all these programs after developing the Old Age Allowance, or OAA. The OAA provides a monthly stipend to all citizens over 70, and widows over 60. There is a small amount of day care for the elderly, but it is limited to the capital. Day care services are expensive, and the general public cannot afford them. Thailand has observed global patterns of an expanding elderly population: fertility control has been encouraged, medical advances have made life difficult, and the birth rate has declined. The Thai government has noticed and been alerted to this trend, but has left care to family members, rather than creating outsourced policies for them. As of 2011, only 25 countries had guaranteed nursing homes, with no more than a few thousand elderly people in each home. Such programs are largely run by volunteers, and the quality of care is questionable, given that care is not always guaranteed. Private care is difficult to follow, and is often based on assumptions. Because children are less likely to be cared for, Their parents; private care is provided. Voluntary NGOs are available but in very limited quantities. While there are certainly elderly care programs in Thailand, equity contributions have increased since their introduction. Richer elderly people in Thailand are more likely to have access to care resources, while poorer elderly people are more likely to use already acquired health care, as noted in a study by Phumisuk Khananurak. However, more than 96% of the country has health insurance, with varying degrees of care available. India’s view of elderly care is similar to Nepal’s. Parents are usually cared for by their children in old age, and it is common for their children to do so. In this country, older citizens, especially men, are held in high esteem. Traditional values demand honor and respect for the elderly, and the wiser. India faces the same problems as its developing counterparts in that its elderly population is growing rapidly, with approximately 90 million people aged over 60. Using data on health and living conditions from the 60th National Survey In India, the study found that nearly a quarter of the elderly suffer from poor health. Reports of poor health clustered around the poor, isolated, less educated, and economically disadvantaged groups. In its 11th Five-Year Plan, the Indian government took many steps similar to those taken by Nepal. The 41st clause of the Indian Constitution states that social security for the health and social welfare of elderly citizens will be ensured. Part of the Criminal Procedure Code, 1973, refers to its traditional background, that sons take care of their parents if they are no longer able to do so. However, NGOs are widespread in India to care for the elderly, providing them with homes and voluntary care, but government policies and organizations are available. Population aging is a challenge worldwide; China is no exception. Due to the “one-child” policy, rural/urban migration, and other social changes; Traditional long-term care for the elderly, which was provided by direct family care, is no longer sufficient. It barely exists now, and both institutional and community services need to expand to meet the growing need. China is still at an early stage of economic development and will face a challenge in meeting these services and training staff. A distinction is generally made between medical and non-medical care, with non-medical care being provided by people who are not medical professionals. Non-medical care is less likely to be insured or covered by public funds. In the United States, 67 percent of the million or so residents of assisted living facilities pay for their care out of pocket. The rest are cared for by family, friends, or state systems. Medicare pays for medical care only if skilled nursing is needed and is provided by certified skilled nursing facilities or by a skilled nursing home agency. Assisted living facilities typically do not meet Medicare requirements. However, Medicare does pay for some skilled care if it is approved. The elderly person that the care met the specifications of the Home Health Grant for the programme. There are 32 states in America that pay for care in assisted living facilities through their Medicaid waiver programmes. Similarly, in the UK, the National Health Service provides medical care for the elderly, and it is free for everyone to use, but social care is the only one paid for by the state in Scotland, but England, Wales and Northern Ireland have not yet introduced legislation on this, so social care is currently only funded by the public authorities when a person exhausts their own resources, for example if they sell their home. The money paid for elderly care in Britain fell by 12% per person in the ten years between 2005 and 2015, and in real terms the fall has been even greater. Experts claim that vulnerable people in Britain are not getting what they need. However, elderly care focuses on satisfying the expectations of two levels of customers: the resident customer and the purchasing customer, who are often different people, because it is parents, relatives or the public authorities who pay for the care rather than the Population. In cases where the elderly are confused or have difficulty communicating; It can be very difficult for relatives or other interested parties to know what level of care is being provided to their loved ones, and they may be constantly concerned that their elderly loved ones are being mistreated there. The Adult Protective Services Agency, a component of the Human Services Agency in most states, is usually responsible for investigating reports of elder abuse in the home and providing families with assistance and guidance. Other professionals such as doctors, nurses, police officers, lawyers, and social workers can also help. Encouraging independence in self-care allows older adults to maintain their independence longer and provides a positive feeling when they accomplish a task without assistance. Older adults who need help with daily activities are at high risk of losing their independence in self-care tasks, as personal behaviors are reinforced by caregivers. It is important for caregivers to make sure that they are putting in place measures to maintain their function, rather than to worsen the condition of older adults with physical limitations. Caregivers need to be aware of the events and behaviors that cause older adults to become dependent. And dependent on others, and also need to allow the elderly patients to maintain their independence as much as possible. Providing information to the elderly about the importance of independence in caring for themselves; allows them to see the benefit of performing self-care independently without needing anyone. If the elderly can do their care activities themselves, or even if they need supervision; Encouraging their efforts to maintain their independence provides them with a sense of accomplishment and the ability to continue to rely on themselves for longer. Deteriorating mobility is a major concern for older adults, affecting 50 percent of people over the age of 85, and at least a quarter of those over the age of 75. Older adults lose the ability to walk, climb stairs, and get out of a chair, becoming completely disabled. The problem cannot be ignored because people over the age of 65 represent the fastest growing segment of the U.S. population. Treatment aimed at improving mobility in older adults usually centers on diagnosing and treating specific problems, such as decreased strength and poor balance. It is appropriate to compare older adults seeking to improve their mobility to runners seeking to improve their time to a certain distance. People in both groups perform better when they link their progress and the work they have done to specific goals related to strength, respiratory capacity, and other physical attributes. The person trying to improve the mobility of an older adult must identify the deficit he or she wants to focus on, and in many cases, there are Little scientific evidence exists to explain any choice. Today, many caregivers focus on leg strength and balance. New research suggests that limb speed and core strength may be important factors in mobility. Family is one of the most important caregivers for an elderly person. In fact, most caregivers for an elderly person are family members, often their daughter or granddaughter. Family and friends can provide a home, provide money, visit to meet their social needs, take them on trips, and so on. One of the biggest causes of deterioration in the elderly is hyponatremia, an electrolyte imbalance that occurs when the sodium level in a person's blood falls below 135 meq/l. Hyponatremia is the most common electrolyte imbalance in the elderly. Studies have shown that elderly patients are more susceptible to this disease due to several factors, including physiological changes associated with aging, such as decreased glomerular filtration rate, the tendency to conserve sodium, and increased vasopressin activity. Mild hyponatremia increases the risk of fracture in elderly patients, because hyponatremia causes severe neurological impairment, which affects walking and attention, similar to moderate alcohol consumption. Incapacity law is a common and sometimes difficult legal process. It requires a person to file a petition in local courts, stating that the elderly person lacks the ability to perform activities that include making medical decisions, voting, making gifts, seeking public benefits, marrying, managing property and finances, and choosing where to live and with whom to socialize. Most state regulations require that at least two doctors or health professionals submit reports as evidence of the person's incapacity, and each person must have a representative. Only then can the individual's legal rights and duties be removed and attributed to his or her agent or guardian. A legal guardian or guardian is a person who is authorized by the court to act on behalf of the incapacitated person and must report regularly to the court on his or her activities. A less restrictive alternative to incapacity law is the use of "advance directives," powers of attorney, living wills, and health care directives. The person who has these documents should prepare them with his or her attorney when he or she is able to do so. Therefore, if the time comes and the person lacks the capacity to carry out the tasks set forth in the documents, the person they have appointed as their "agent" can step in and make these decisions on their behalf. This person has a duty to do this to the best of his or her ability and with the utmost care.

Geriatric medicine

Futile care is the continuation of health care and treatment for a patient despite the lack of reasonable benefit or hope of cure. It may take the form of surgery for advanced cancer despite the fact that it does not help or cure the disease or continuing to put a brain-stem-dead patient on a ventilator. Futile care is a sensitive issue that must be approached with caution and professionalism. It is often debated between health care providers and each other and between the elderly's families and each other. This is due to the lack of clarity about all the facts of the care or the patient's current situation or the suffering of loss. Health care is one of the means of maintaining and restoring health to improve the quality of life of the elderly. The decision to accept or refuse health care is an important, vital and complex one. This decision is governed by many variables such as the ethics and regulations of the profession, traditions and beliefs, the availability of eligibility, the educational level of the elderly and their family, the availability of communication skills, and the time, information and health education experience of the health care provider.

Geriatric medicine

Falls are a major cause of illness and even death for the elderly, and are among the preventable causes of injury. The causes of falls for the elderly depend on several factors and may require several precautionary measures to treat any injury that caused a previous fall and prevent future falls. Falls include collapsing from a standing position or from places where a person is exposed to falling, such as stairs. The severity of the fall depends largely on the height from which the person fell, but the nature of the ground on which the person fell also plays a role in the severity of the fall; falling on a hard floor causes more damage than falling on a soft floor. Falls can be avoided by taking several measures, such as ensuring that the carpet is attached to the ground and not raised above it, keeping electrical wires away from walking areas, wearing shoes with low heels and rubber bottoms, ensuring that the person's hearing and visual abilities are working efficiently and at their best, and avoiding walking if the person is dizzy or has consumed a large amount of alcohol. The European Food Safety Authority has conducted several studies which have shown that it is preferable for the elderly, especially those over 60, to include vitamin D as a nutritional supplement to reduce the risk of falls and osteoporosis, and falls are an aspect of great importance in the field of geriatrics. Other definitions are more comprehensive and do not exclude “major events” as falls. Falls are of great importance, especially in medical treatment facilities, and fall prevention measures are a priority in health care services. In 2006, a publication was presented urging the development of a definition for naming falls due to the clear differences in its definition that appeared in several other studies. The European Association for Fall Prevention has developed a definition of falls and recorded cases resulting from falls in an attempt to alleviate this problem. ProFane states that a fall is an unexpected event in which a person falls from a high place to the ground or to a lower place. This definition developed by ProFane is now used as a framework for evaluating research and studies related to the subject of falls. Falls have many causes. A person can live with many factors that may one day lead to a fall, but the problem begins to appear with the emergence of a new, unprecedented factor. Therefore, treatment is often specific to the cause of the fall and not to treat all the factors that may lead to the accident. These factors can be divided into two groups: a group that includes the presence of a disease or a specific condition that caused the fall, and another group that includes external factors such as the surrounding environment and how it affects the fall, such as the lighting of the place. When evaluating a person who has fallen to the ground, it is important to obtain the statements of anyone else who witnessed the incident, as the person who fell may have suffered from loss of consciousness, which leads to an inaccurate description of the incident, but these witnesses are often not available. It should also be taken into account that about 30% of mentally and cognitively healthy older adults cannot remember a previous fall that occurred more than 3 months ago. Important points to examine: Fall prevention is primarily done after identifying the causes that lead to such an accident. A lot of evidence indicates that when making an effort that includes doing some exercise, the risk of future falls is reduced. There are several things that can be done to reduce the occurrence of such an incident, such as: Interventions to reduce the consequences of falls: People admitted to hospital are at risk of falling, and a randomized trial showed that the use of a set of special tools led to a decrease in the rate of falls in hospitals. Nurses prepare a complete scale of risks and factors that cause falls, through which a complete system is created aimed at addressing the main reasons that cause people to be exposed to this incident. These tools also include posters that are placed on patients’ beds with a brief text about how to prevent this incident from happening again in the future. Both the American Society and the British Society of Geriatric Medicine recommend that all older people undergo regular screening to see if they have had any type of fall in the past year; as having had this incident in the past is a major factor in its recurrence in the future. Older people who have had at least one fall in the past six months or who think they may have one in the coming months should be screened to reduce the risk of recurrent falls. Several health organizations in the United States have developed screening questionnaires. These questionnaires include questions about difficulty walking or balance, use of medications to help sleep or regulate mood, loss of sensation in the feet, vision problems, fear of falling, and use of walking aids. Older adults who report falling should be asked about their circumstances and frequency of falls to assess the risk to walking and balance that may be causing the fall. A fall risk assessment is performed by a physician and includes a history of any past falls, a physical examination, a functional assessment, and an environmental assessment. Falls increase gradually with age. According to current research, approximately one-third of older adults experience one or more falls each year, while 10% experience multiple falls each year. However, the risk is much higher for people over age 80, where the annual fall rate can reach 50%. Researchers have been working together to define falls since the 1980s and have finally come to define a fall as “an event that results in the unintentional impact of a person on the floor or other lower level and is not necessarily the result of a significant event or imminent hazard.” The impact on health care and costs of falls in older adults is increasing dramatically worldwide and the cost of falls is categorized into two types: direct costs and indirect costs. Direct costs are what patients and insurance companies pay to treat injuries caused by falls. This includes fees for hospitals, nursing homes, doctors and other professional services, rehabilitation, community services, the use of medical equipment, prescription drugs, and changes to the home to ensure that the event does not occur again. Indirect costs include the loss of productive capacity of the family and the long-term effects of falls such as physical disability, dependency, and reduced quality of life. In the United States alone, the total cost of fall-related injuries for people over age 65 was $31 billion in 2015. The costs included millions of emergency room visits, nonfatal injuries, and more than 800,000 hospitalizations, and it is estimated that by 2030 the annual number of fall injuries will reach 74 million seniors.

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Geriatric medicine

Sarcopenia is actually a degenerative loss of skeletal muscle mass, efficiency and strength due to aging or lack of movement, and it is a disease that may be defined as any pathological or abnormal condition that affects muscle tissue, especially skeletal muscle, in which muscle weakness is the primary complaint, as a result of the inability of the affected muscles to perform their functions to the fullest extent. Therefore, muscle weakness or sarcopenia is a disease that affects muscle fibers, which leads to their inability to perform their function for several reasons, resulting in weakness in the muscle in general. Sarcopenia expresses a defect in the muscle itself, despite the efficiency of the nerve or nerves connected to it, and differs from problems that arise from a defect in the nerves or higher brain centers. Accordingly, muscle diseases can be classified according to their nature into two main categories: the first is neuromuscular disorders, which includes several types, and the second is what is known as the musculoskeletal motor type, while what is known as polymyositis can be considered a mixture of the two previous types. There was no specific and unified general medical definition for sarcopenia until 2009. A group of European doctors identified sarcopenia in the elderly and developed a general medical and diagnostic definition for age-related sarcopenia. Sarcopenia is diagnosed when there is a decrease in muscle mass and a decrease in motor ability. Sarcopenia or muscle weakness can be divided into several groups, some of which are hereditary, and some are acquired as a result of contracting another disease. The most famous of these are those that occur as a result of taking certain substances or medications, and some of which occur with some diseases, such as polio, and some of which occur with skin infections, as we will list as follows: As for doctors, the modern classification of sarcopenia is through the modern international classification, approved by the World Health Organization and known as the ICN - Codes, which we mean the international statistical classification of diseases and health problems, which includes more than 14,400 codes, which leads to many modern diagnoses of diseases, which then reach more than 16,000 codes. As for the symptoms of the disease, they can be summarized as a weakness in the person's or child's ability to use the affected muscles, and the matter may develop into repeated contractions, or muscle stiffness, and muscle spasms may occur. As for the treatment, because its causes are numerous and vary in the ways they occur, there is no comprehensive treatment method for all types, but it differs from one type to another. There are some types that benefit from some drug treatments, and some of them require physical therapy, and some of them require treatment with acupuncture, and recent research has begun to benefit from the system and science of stem cells to treat some types of this disease. However, periodic follow-up with the attending physician remains the most important thing in the subject, for several reasons, including knowing the development of the condition, and the extent of the effect of drug or physical therapy on not developing complications of the disease, as well as following up on all new modern treatment methods that may develop, which may benefit these patients. An accurate diagnosis of the type of atrophy or weakness of the meat is very important, because it is the first step in determining the type of treatment program appropriate for the case. It is known that a careful clinical examination by the examining physician of the patient is the first thread of diagnosis, through an accurate medical history and an accurate clinical examination. Then there is an initial laboratory examination of a specific enzyme. If its levels are high, we begin examining the affected muscles through electromyography. We may often need to perform a puncture operation on part of the affected muscles, to know the histopathological analysis of these tissues in the muscles, which allows for estimating the ideal treatment program for each case individually.

Geriatric medicine

Geriatric dentistry is the provision of dental care to older adults, including the diagnosis, prevention, and treatment of age-related problems and age-related diseases as part of a specialized team with other health care professionals. The past century has seen a number of striking statistical changes in the health, disease, longevity, and mortality of populations around the world. Currently, one-third of the world's elderly population lives in developing countries, and one in twelve people in these developing countries is over the age of sixty-five. The twentieth century witnessed a significant aging of the global population in terms of life expectancy, and the twenty-first century is set to see significant gains in longevity worldwide, both in developed and developing countries. This increase in life expectancy is primarily due to the significant reduction in mortality rates throughout the lifespan that has occurred with the development of health care facilities, sanitation, environmental and public health improvements coupled with better hygiene and living conditions. As a result of increasing life expectancy, the proportion of elderly people in the total population is expected to be around 25% in India and 32% in developed countries by 2050. Taking this increase in life expectancy into account, the retirement age in many sectors in India is increasing, in some of them it may even reach 70 years. In some states, the retirement age has not been increased due to concerns about the eventual loss of jobs to the younger generation. According to the Government of India’s classification, elderly people are those aged 60 years or above; these citizens become eligible for various exemptions and concessions granted by the government and other agencies. In developing countries, elderly people are those above 65 years. The mouth is considered a mirror of overall health, and hence oral health is an integral part of overall health. Poor oral health in an elderly population is a risk factor for overall health problems. On the other hand, elderly people are more susceptible to oral conditions and diseases due to the increase in chronic conditions and physical and mental disabilities. Thus, the elderly constitute a prominent group with regard to precautionary care. The dental diseases that the elderly are most susceptible to are root caries, erosion, periodontal disease, tooth loss due to early neglect, edentulism, poor quality of the alveolar margin, poorly fitting dentures, mucosal lacerations, oral ulcers, dry mouth, oral cancers, and extensive caries. Many of these are consequences of neglect in the early years of life, e.g. consumption of carious foods, lack of awareness regarding preventive aspects, and habits such as smoking and/or tobacco, frying, and chewing betel nut. All of these problems can be significantly aggravated by the decline in immunity with age and by coexisting health problems. As a result of poor systemic health, elderly patients do not pay enough attention to their oral health. In addition, medications such as antihypertensives, antipsychotics, antianxiety drugs, etc., lead to dry mouth, and the loss of the protective effect of saliva in the oral cavity increases the susceptibility to oral diseases. Financial constraints, lack of family support or transportation are major barriers to accessing dental services in later life. Untreated oral cavity has detrimental effects on comfort, aesthetics, speech, chewing and, consequently, quality of life in old age. The extent of root caries in the elderly can be as high as 1.6 root surfaces for every root surface at risk. The nature of root caries in men is more severe and is more pronounced in the molar area. Several major factors are associated with the development of root caries including decreased salivary flow, poor manual dexterity and systemic infections requiring the use of drugs that cause decreased salivation. In addition, more serious risk factors include erosion of the cementum enamel margin, clinical preparation for a fixed bridge, removable dentures and a restricted diet that includes refined sugars and viscous and fermentable carbohydrates. Prevention and treatment of root caries include topical fluoride application and nutritional counselling on diet planning, prevention of plaque formation and prevention of gum recession. Conservative dental treatment for the elderly must take into account dental, functional and medical considerations to ensure a level of care equivalent to that of younger patients, as well as taking into account the structural changes that have occurred in the tooth and the health status when preparing conservative treatment for the elderly patient. Dental implants have become a strategic measure to replace missing teeth and as a dental component of the treatment plan for elderly patients, dentists should generally consider this type of treatment during their training. The elderly often resort to replacing missing teeth, but they face medical, social and economic complications that must be taken into account when preparing the treatment plan. Dentists should pay full attention to the assessment of the patient's ability, diagnostic criteria and diagnostic procedures to help the patient and his/her family understand the risks and challenges of each type of dental prosthetic treatment. It is important to compare implants with fixed and removable prosthetics. For a large number of dentists, dental implants are becoming a more popular option for replacing missing teeth. With the increasing proportion of the elderly population around the world, dentists will encounter many medically and socially complex cases whose owners desire dental prosthetic treatment. Therefore, it is necessary to increase attention to this branch of dentistry during the period of training of doctors.

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Geriatric medicine

Geriatrics or geriatric medicine is the branch of medical science that deals with the health of the elderly and the elderly. It aims to study the health of the elderly and treat common diseases of old age and treat the effects and disabilities resulting from them. Gerontology was initially affiliated with internal medicine, then it became a science in its own right, like pediatrics. It is known to devote its attention to the care of the elderly, diseases characteristic of the elderly, and problems that affect people with advancing age. To improve the quality of life and stimulate increased safety and preserve dignity, comfort and independence for the elderly. It arose due to the special nature of the elderly and their differences from other age groups. It is also known as geriatrics, geriatric medicine, and dentistry. It is concerned with treating diseases of the elderly and preserving their health by conducting a comprehensive assessment of the elderly and providing medical education to patients, their families, and the caregiver team on the difference between natural aging and pathological aging in the elderly and achieving healthy aging through preventive measures such as elderly vaccinations and others and the benefits of medical screening for some diseases; consultations on sports and nutrition in the elderly. The elderly are distinguished by their special nature from other age groups due to the difference in the performance of the body's organs of their functions. It is necessary to differentiate between changes that occur in the functions of each organ of the body and diseases that occur in each organ. For example, a decrease in functional reserve in the kidneys is considered a natural change with old age, but renal insufficiency or renal failure is considered a disease in any age group. Cases of confusion/delirium, senile dementia and Alzheimer's disease, depression or anxiety, drug overuse disorders and drug interactions, movement and balance disorders and falls, urinary incontinence, dehydration and malnutrition, chronic pain, problems of bedridden patients, osteoporosis, dealing with various ulcers, rehabilitation and physical medicine for the elderly, sensory impairment, palliative care and terminal care. Such as femoral neck fracture, pressure ulcers, deep vein thrombosis, acute arterial insufficiency, prostate diseases and preoperative medical evaluation. The geriatric medical care team consists of geriatricians, rehabilitation physicians, nurses, psychologists, dietitians, cognitive and speech rehabilitation specialists, occupational therapists, and social workers. There are some sub-branches within the geriatric specialty such as geriatric psychiatry and cardiology of the elderly. Some modern care methods that are already provided or can be provided to the elderly. It is a sub-system of social policy and is the mechanism used by governments to allocate limited resources and as such deals with multiple variables such as limited resources, unmet needs, and poorly defined goals.

Geriatric medicine

Geriatric psychiatry, also known as geriatric medicine or gerontological psychiatry, is a branch of medicine and a subspecialty of psychiatry that deals with the study, prevention, and treatment of neurodegeneration, cognitive impairment, and mental disorders in older adults. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatrics, behavioral neurology, neuropsychiatry, neurology, and general psychiatry. Geriatric psychiatry has become a formal subspecialty of psychiatry with a defined curriculum and core competencies. The origins of geriatric psychiatry began with Alois Alzheimer, a German psychiatrist and neuropathologist who first identified amyloid plaques and neurofibrillary tangles in a fifty-year-old woman he named Auguste Dieter. These plaques and tangles were later identified as responsible for her behavioral symptoms, short-term memory loss, and psychiatric symptoms. These brain abnormalities would become the determinants of what later became known as Alzheimer's disease. The subspecialty of geriatric psychiatry originated in the United Kingdom in the 1950s. The geriatric unit, the term for a hospital-based geriatric psychiatry program, was first introduced in 1984 by Norman White, when he opened New England's first specialty program at a community hospital in Rochester, New Hampshire. White is a pioneer in geriatric psychiatry, being among the first psychiatrists in the nation to be board certified in the field. The prefix psychiatry was suggested for the geriatric program, but White, who knew the New Englanders' aversion to anything psychological, successfully pressed for the name geriatrics rather than psychiatry. Diseases and disorders diagnosed or managed by geriatric psychiatrists include: A geriatric psychiatrist is a physician who specializes in the medical subspecialty called geriatric psychiatry. A geriatric psychiatrist is board-certified after specialized training following a medical degree, residency, and additional geriatric psychiatry fellowship. Requirements may vary by state. Geriatric psychiatrists are also psychiatrists qualified in the general diagnosis and treatment of mental disorders. Some geriatric psychiatrists also conduct research to determine the cause and best treatment for neurodegenerative disorders and mental health disorders in later life. Geriatric psychiatrists may perform neurological examinations, mental status examinations, laboratory tests, neuroimaging, and cognitive assessments to investigate the causes of psychiatric or neurological symptoms in old age. The International Geriatric Psychiatry Association is an international community of scientists and geriatric care professionals working in the field of geriatric mental health. International Geriatric Psychiatry is the official journal of the International Psychiatric Association. The Royal College of Physicians and Surgeons of Canada is responsible for the training and certification of geriatric psychiatrists in Canada. Geriatric psychiatry requires an additional year of subspecialty fellowship training in addition to general psychiatric training. The Royal College of Psychiatrists is responsible for the training and certification of psychiatrists in the United Kingdom. Within the Royal College of Psychiatrists, the Faculty of Geriatric Psychiatry is responsible for training in geriatric psychiatry. Physicians who are members of the Royal College of Psychiatrists can undertake a three- or four-year training program to become a geriatric psychiatrist. There is currently a shortage of geriatric psychiatrists in the United Kingdom. The American Geriatric Psychiatry Association is a national organization representing health care providers who specialize in late-life mental disorders. The American Journal of Geriatric Psychiatry is the official journal of the association. Both the American Board of Psychiatry and Neurology and the American Osteopathic Board of Neurology and Psychiatry issue board certification in geriatric psychiatry. After a 4-year residency in psychiatry, a psychiatrist can complete a 1-year fellowship in geriatric psychiatry. There are several geriatric psychiatry fellowships.

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Geriatric medicine

The word “longevity” is sometimes used synonymously with “life expectancy” in demography—especially when it concerns someone or something that lives longer than expected—however, the two words have slightly different definitions. In a similar vein to “discipline” and “precision,” “longevity” refers to the average number of years a human being lives, while “life expectancy” refers to the number of years the average population lives. This is illustrated by the fact that a large increase in life expectancy can be accompanied by a small increase in the overall longevity of the population. Speculations about longevity have gone beyond the recognition of the shortness of human lifespans, and have included consideration of ways to prolong life. The topic of longevity has been raised not only in the scientific community but also among travelers, science fiction writers, and utopian novelists. There are many difficulties in ascertaining the absolute longest human lifespan by contemporary standards, due to inaccurate or incomplete birth statistics. Novels, myths, and folklore have claimed past or future lifespans that are much longer than those proven by modern standards, and unconfirmed claims of longevity continue to abound, with talk of cases of longevity in the present.

Geriatric medicine

The geriatric medical care team consists of geriatricians, rehabilitation doctors, nursing staff, psychologists, nutritionists, cognitive and verbal rehabilitation specialists, occupational therapists, and social workers. He has postgraduate studies and clinical training in geriatric medicine: His role in the care team: The problem is defined as a disability or something that is functionally and structurally harmful and stands in the way of satisfying human needs, or a condition that is believed to threaten social value, but can be changed through constructive social actions. It is also defined as the difficulties that a person is exposed to and that affect his behavior, actions, performance, and relationships with others, and their presence may result in undesirable consequences that affect social life as a whole. Thus, the problems of the elderly can be defined as individual or collective non-consensual situations that hinder their social adaptation to their social environments, and hinder their investment of available resources. The health status of the elderly depends on a set of social factors such as the standard of living, the level of education, the extent of his interest in periodic medical examinations and his ability to bear the costs of treatment or not, in addition to the extent of the elderly and his family's awareness of the diseases of old age and the elderly's neglect of himself and not asking for help until his condition worsens. The health of the elderly is also affected by the type and quantity of food, the nature of the profession in which he worked, and the environment to which he belongs, whether natural or social, because the frequent use of any part of the body delays aging. The most important diseases that the elderly are exposed to: If the physical disease imposes some precautions and restrictions on the patient in his way of life, then psychological problems affect the patient and hinder his compatibility, and it is possible that it has physical symptoms including weight loss and constipation. Among the most important problems that the elderly suffer from: Mental problems of the elderly are represented in senile psychosis, which includes memory loss and forgetfulness, and paranoia disorders. Have postgraduate studies and clinical training in geriatric nursing: Role in care: • Organizing the transfer and admission of patients to the department. • Providing medical education to the patient, his family and caregivers. • Coordinating patient care by the rest of the geriatric care team during the team meeting. • Evaluating the patient. • Setting treatment goals and developing. • Reviewing the treatment plan. The social worker uses the system analysis model in social work by the two scientists "Allen Banks and Ann Minahan" to enhance the effectiveness of professional intervention to address problems and situations with the elderly. The general practitioner helps in addressing multiple problems of systems of dealing in the field of geriatric care by using different methods as well as when assuming many roles. The role is a behavior and activity that is united in performing some specific tasks and responsibilities. The most important roles of the general practitioner in the field of geriatric care: Physical medicine doctor and rehabilitation specialist: Selecting the appropriate patient for treatment by the geriatric doctor and the geriatric care team: Studies have shown that medical geriatric care programs achieve success with certain cases of elderly patients. Studies have not proven the relationship between chronological age and benefit from medical geriatric care programs. Although as age increases, problems of multiple morbidities, frailty, and common geriatric syndromes increase. Characteristics of elderly patients who will likely benefit from geriatric care programs: § Chronological age 60 years or older § Multiple medical problems, functional performance problems, and some psychological and social problems. § Age who suffers from one or more common geriatric syndromes such as: dementia, delirium, functional decline, urinary incontinence, polypharmacy, elderly abuse, unsteady gait/falls, malnutrition, or depression. Characteristics of elderly patients who will likely not benefit from geriatric care programs:

Geriatric medicine

Risk dignity is the idea that self-determination and the right to take responsible risks are essential to dignity and self-esteem and should not be denied by overly cautious caregivers concerned with their duty of care. The concept applies to adults in care, such as elderly caregivers, people with disabilities, and people with mental health problems. It also applies to children, including children with disabilities. Allowing people in care to take risks is often seen as a counter to the duty of caregivers to care. It can be difficult to balance these conflicting considerations when developing policies and guidelines for caregiving. Overprotection of people with disabilities results in low self-esteem and lower achievement because of the low expectations that accompany overprotection. Internalization of low expectations causes a person with a disability to believe that they are less capable than others in similar situations. In older people, overprotection can lead to learned dependency and reduced ability to care for themselves. Physical care can have positive outcomes and enable the individual to function at their full potential. However, if they are not included in the caregiving process, allowed to make decisions, and respectfully assisted in their daily activities, it is likely to lead to psychological harm by weakening and undermining the dignity of that individual.

Geriatric medicine

Tea and toast syndrome is a common form of malnutrition in older adults who are unable to prepare meals for themselves, and so their diet is limited to tea and toast, resulting in vitamin and other nutrient deficiencies. This syndrome often manifests as hyponatremia due to a lack of salt in the diet. This syndrome often occurs when children move out of the home or when a spouse dies or is near death. An older adult who is left alone with no one to prepare food for him or her and lacks the skills to prepare food for himself will resort to a diet of simple foods such as bread, cheese, crackers, and canned foods. According to the New York Times, up to 60 percent of older adults living at home are malnourished or at risk of malnutrition. In addition to the problems caused by nutritional deficiencies, this condition means that complications from other illnesses, even the common cold, can be extremely dangerous. Factors that lead to this syndrome include social isolation, psychological problems such as depression, illnesses, and physical limitations. The increasing number of medications that older adults take can affect eating habits, although this is a less serious factor than psychological problems. However, these medications can reduce appetite, change the taste of food, or affect the way nutrients are absorbed, making it difficult for older adults to get the nutrients they need. Typical laboratory findings for tea-and-toast syndrome include low serum osmolality with normal urine osmolality, because antidiuretic hormone levels are normal.

Geriatric medicine

Parkinson's disease, also known as shaking palsy, is a degenerative disorder of the central nervous system that mainly affects the motor system. Symptoms start slowly at the onset of the disease, the most noticeable being tremors, contractions, decreased movement and gait abnormalities. Problems with thinking and behavior may also occur. Dementia becomes common in the later stages of the disease. Depression and anxiety are also common symptoms, occurring in more than a third of people with Parkinson's disease. Sensory symptoms include sleep disturbances and emotional problems. The main motor symptoms are collectively called "parkinsonism", or "parkinsonian syndrome". The cause of Parkinson's disease is generally unknown, but is thought to involve genetic and environmental factors. There is also an increased risk in people exposed to certain pesticides and among those who have had head injuries, while there is a lower risk in tobacco smokers and those who drink coffee or tea. The motor symptoms of the disease result from cell death in the substantia nigra, an area of the midbrain. This leads to insufficient dopamine in these areas. The cause of cell death is not understood, but it involves the accumulation of proteins in the bodies of the brain. Lewy in neurons. Diagnosis of typical cases is based mainly on symptoms, with tests such as neuroimaging used to rule out other diseases. There is no cure for Parkinson's disease. Initial treatment is usually the antiparkinsonian drug levodopa with a dopamine agonist. As the disease progresses, neurons continue to be lost, so these drugs become less effective. Diet and some forms of rehabilitation have shown some effectiveness in improving symptoms. Neurosurgery to place microelectrodes to stimulate the brain has been used to reduce motor symptoms in severe cases when drugs are ineffective. In 2015, Parkinson's disease affected 6.2 million people and resulted in about 117,400 deaths worldwide. Parkinson's disease usually occurs in people over the age of 60. Males are more affected than females. When the disease affects people under the age of 50, it is called juvenile Parkinson's disease. The average life expectancy after diagnosis of Parkinson's disease is between 7 and 14 years. The disease was discovered by the English physician James Parkinson, who published the first detailed description in a paper on shaking palsy, in 1817. Public awareness campaigns include World Parkinson's Day and the use of a red tulip as a symbol for the disease. People who have suffered from Parkinson's disease and have helped raise public awareness of the condition include actor Michael J. Fox, Olympic cyclist Davis Finney, and the late boxer Muhammad Ali. The movement difficulties found in Parkinson's disease are called "parkinsonism." The motor symptoms of "parkinsonism" are bradykinesia (slowness in initiating voluntary movements, with a gradual decrease in speed), plus one of three other physical signs: muscle rigidity, tremor, and postural instability. Parkinson's disease is sometimes called "idiopathic Parkinsonism," because no specific cause is known. Identifiable causes of Parkinson's disease include toxins, infections, drug side effects, metabolic deterioration, and brain lesions such as strokes. Several neurological disorders can also occur with Parkinsonism, sometimes referred to as "atypical Parkinsonism" or "Parkinsonism plus." They include multiple system atrophy, progressive supracentral palsy, Cortical degeneration, dementia and Lewy body disease. Scientists sometimes refer to Parkinson's disease as a synucleinopathy to distinguish it from other neurodegenerative diseases, such as Alzheimer's disease, in which the protein tau accumulates in the brain. There is considerable clinical and pathological overlap between tonopathies and synucleinopathies. In contrast to Parkinson's disease, Alzheimer's disease is most commonly associated with memory loss, and the cardinal signs of Parkinson's disease are not typical features of Alzheimer's disease. Dementia and Lewy body disease are closely related to Parkinson's disease. The relationship between Parkinson's disease and Lewy body disease is quite complex. They may represent parts of a continuum with distinct clinical and pathological features or may prove to be separate diseases. The most characteristic symptom of Parkinson's disease is difficulty with movement. Non-motor symptoms, which include autonomic dysfunction, neuropsychiatric problems, sensory and sleep difficulties, are also common. Some of these non-motor symptoms may be present at the time of diagnosis. The four cardinal motor symptoms in Parkinson's disease are tremor, decreased The most common motor symptom in Parkinson's disease is a slow tremor of the hand that disappears during voluntary movement of the affected arm and in the stages of deep sleep. This tremor usually occurs in one hand, but the other hand eventually becomes affected as the disease progresses. The tremor frequency in Parkinson's disease is between 4 and 6 hertz per second. A characteristic of the hand tremor is the tendency of the index finger and thumb to touch each other and make a circular motion. Hypokinesia is present in all cases of Parkinson's disease, and is due to disturbances in the motor planning of movement initiation, and is associated with difficulties along the movement process, from planning to initiation to execution of a movement. Motor performance is impaired. Bradykinesia is the most disabling symptom of Parkinson's disease, leading to difficulties in daily tasks such as dressing, feeding, and bathing. It leads to particular difficulty in performing two independent motor activities at the same time, and can be worsened by psychological stress or concurrent illnesses. Ironically, patients with Parkinson's disease can often ride a bicycle or climb a mountain. Stairs are easier to climb than walking. While most doctors may easily notice slowness of movement, a formal evaluation requires the patient to make repetitive movements of the fingers and toes. Rigidity is a symptom of Parkinson's disease and is a stiffness and resistance to movement of the limbs caused by increased muscle tone and excessive and persistent muscle contraction. Rigidity is a combination of tremor and increased muscle tone at the same time. Rigidity may be associated with joint pain. This pain is a frequent initial manifestation of the disease. In the early stages of Parkinson's disease, rigidity is often asymmetrical and tends to affect the neck and shoulder muscles before the face and limbs. As the disease progresses, rigidity usually affects the entire body and reduces the ability to move. Postural instability is common in the later stages of Parkinson's disease, leading to poor balance and frequent falls that can lead to bone fractures, loss of confidence, and decreased mobility. Instability is often absent in the early stages, especially in young people, especially before the onset of bilateral symptoms. Up to 40% of people diagnosed with Parkinson's disease fall to the ground frequently. Other recognized signs and symptoms include The symptoms that affect the patient's motor system are: , and also signs: quiet voice, a face that does not move, and the patient's handwriting becomes noticeably smaller over time. Parkinson's disease can cause neuropsychiatric disorders, which can range from mild to severe disorders. These include disorders of perception, mood, behavior, and thought. Cognitive disorders can occur in the early stages of the disease and sometimes before diagnosis, and these disorders increase with increasing age of the patient and the progression of the disease stages. The most common cognitive deficit in Parkinson's disease is impaired execution and planning, which can include problems with planning, cognitive flexibility, abstract thinking, inhibiting inappropriate actions, initiating appropriate actions, and working memory. Other cognitive difficulties include slow cognitive processing speed, decreased neurotransmission, poor perception, and time estimation. Vision problems are also part of the disease, for example, when an individual is asked to perform facial recognition tests and perceive the direction of drawn lines, they cannot easily determine this. A person with Parkinson's disease has two to six times the risk of dementia compared to the general population. The prevalence of dementia increases with age and the length of the disease. Dementia is associated with With a reduced quality of life for people with Parkinson's disease and their caregivers, the patient is more likely to require home nursing care. Behavior and mood changes are more common in Parkinson's patients without cognitive impairment than in healthy people, and behavioral and mood changes are often associated with dementia. The most common mood problems are depression, apathy, and anxiety. Diagnosing depression is complicated by the fact that the body language of depression can masquerade as Parkinson's disease, such as a sad, expressionless face, slow movements, and a quiet, broken voice - all of which could be Parkinson's disease or just depression, and thus distinguishing between them using these symptoms alone is very difficult. Up to 30% of people with Parkinson's disease may have symptoms of anxiety, ranging from generalized anxiety disorder to social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Dissociative identity disorder, in which repetitive, purposeless, stereotyped behaviors occur only for a few hours, is another disorder caused by anti-Parkinson's medication. Hallucinations or delusions occur in about 50% of people with Parkinson's disease over the course of the disease, and can be a sign of Dementia. These range from minor hallucinations—“feeling like you’re passing by” or “feeling like you’re there”—to visual hallucinations and paranoid thoughts. Auditory hallucinations are uncommon in Parkinson’s disease, and are rarely described as voices. Psychosis is now thought to be an integral part of the disease. Psychosis with associated delusions and delirium is a recognized complication of anti-Parkinson’s therapy and can also be caused by urinary tract infections, but drugs and infections are not the only factors behind the pathology or changes in neurotransmitters or their receptors are thought to play a role in psychosis in Parkinson’s disease. In addition to neuropsychiatric and motor symptoms, Parkinson’s disease can be compounded by problems with other systems. Sleep problems are a feature of the disease and can be exacerbated by medications. Symptoms can include daytime sleepiness, sleep disturbances, or insomnia. Rapid eye movement (REM) sleep, where the patient acts as if they are dreaming, and sometimes injures themselves or their bed partner, may begin many years before the motor system or cognitive features of Parkinson’s disease develop. Changes in the autonomic nervous system can lead to orthostatic hypotension, seborrheic dermatitis, excessive sweating, urinary incontinence, and altered sexual function. Constipation and stomach weakness can be severe enough to cause discomfort and even endanger health. Changes in cognition may include a poor sense of smell, blurred vision, and pain. All of these symptoms can occur years before the disease is diagnosed. Exposure to pesticides and head injury have been linked to Parkinson's disease, but the risk is relatively low. People who have never smoked cigarettes have an increased risk of Parkinson's disease and moderate consumption of caffeinated beverages increases the risk of the disease. Low serum concentrations of urate may increase the risk of Parkinson's disease. Parkinson's disease is presumed to be a non-inherited disorder, but it appears to be the product of a complex interaction of genetic and environmental factors. About 15% of individuals who have a close relative with the disease also have the disease, and 5-10% of people with Parkinson's disease may be caused by a mutation in one of several specific genes. These gene mutations lead to the disease, and they put an individual at increased risk, often in combination with other risk factors, but in most cases, people with these mutations will develop Parkinson's disease. The genes involved in the development of Parkinson's disease are: alpha-synuclein, LRRK2, GBA, PRKN, PINK1, PARK7, VPS35, EIF4G1, DNAJC13 and CCHHD2. SNCA gene mutations are important in Parkinson's disease because the protein the gene encodes, alpha-synuclein, is a major component of Lewy bodies that accumulate in people's brains. Mutations in certain genes, including SNCA, LRRK2, and GBA, have been found to be risk factors. Mutations in the LRRK2 gene are the most common cause of Parkinson's disease, accounting for about 5% of individuals with a family history of the disease and 3% of sporadic cases. A mutation in GBA greatly predisposes a person to the development of Parkinson's disease. Several genes associated with the disease are involved. Parkinson's disease in lysosomal function. It has been suggested that some cases of Parkinson's disease may be caused by lysosomal dysfunctions that reduce the cells' ability to break down alpha-synuclein. The main pathology of Parkinson's disease is cell death in the basal ganglia of the brain as well as in many of the remaining neurons. This is accompanied by neuronal loss, astrocyte death, and a significant increase in the number of microglia in the substantia nigra. There are five major pathways in the brain that connect other brain regions to the basal ganglia. These are known as the motor cortex, oculo-motor cortex, temporal cortex, limbic system, and orbitofrontal cortex. All of them are affected in Parkinson's disease, and disruption of these brain regions explains many of the symptoms of the disease, because these circuits are involved in a wide range of functions, including movement, attention, and learning. There is a particular conceptual model of the motor system and its alteration in Parkinson's disease that has been influential since the 1980s, although some limitations have led to some modifications. In this model, the basal ganglia typically exert a persistent inhibitory influence on a wide range of systems. Motor, preventing them from becoming active at inappropriate times. When a decision is made to perform a certain action, the inhibition of the required motor system is reduced, thus releasing it for activation. Dopamine acts to facilitate this release from the motor system, so high levels of dopamine tend to promote motor activity, which is what happens in Parkinson's disease where the patient requires more effort for any given movement. Thus, the net effect of dopamine depletion is to produce hypokinesia, a general decrease in motor output. Drugs used to treat Parkinson's disease may work by increasing dopamine, allowing motor systems to be activated. There are several mechanisms by which brain cells can be lost. One mechanism consists of an abnormal accumulation of the ubiquitin-bound protein alpha-synuclein in damaged cells. This insoluble protein accumulates within neurons forming derivatives called Lewy bodies. According to Braak, the disease is classified on the basis of pathological findings. Lewy bodies first appear in the olfactory bulb, medulla oblongata and pontine tegmentum. Individuals at this stage may be asymmetrical or may have They have early non-motor symptoms. As the disease progresses, Lewy bodies develop in the substantia nigra, areas of the midbrain and basal forebrain, and finally, the neocortex. These sites in the brain are the main sites of neuronal degeneration in Parkinson's disease. However, Lewy bodies may not cause cell death and may be protective. Other forms of alpha-synuclein that do not aggregate into Lewy bodies while Lewy neurites are toxic forms of the protein. In people with dementia, Lewy bodies are common in cortical areas. Neurofibrillary tangles and senile plaques, which are characteristic of Alzheimer's disease, are not common unless the person is demented. Other mechanisms of cell death include dysfunction of the proteasomal and lysosomal systems and reduced mitochondrial activity. Iron accumulation in the substantia nigra is often seen in conjunction with protein inclusions. It may be related to oxidative stress, protein aggregation, and neuronal death, but the mechanisms are not fully understood. The physician initially evaluates Parkinson's disease with a history Careful medical and neurological examination. The patient may be given levodopa, and any resulting improvement in motor system dysfunction helps to confirm the diagnosis of Parkinson's disease. The finding of Lewy bodies in the midbrain on autopsy is usually considered definitive evidence that the person has had Parkinson's disease. The clinical course of the disease over time may reveal it is not Parkinson's disease, requiring periodic review of the clinical presentation to confirm the diagnosis. Other causes that can secondarily resemble Parkinson's disease are stroke and drugs. Progressive suprarenal palsy and multiple system atrophy should be excluded. Antiparkinsonian drugs are usually less effective in controlling symptoms in Parkinson's plus syndromes. Rates of progression, early cognitive impairment, or postural instability may initially indicate Parkinson's disease. Genetic forms with an autosomal or recessive pattern of inheritance are sometimes referred to as familial Parkinson's disease. Medical organizations have developed diagnostic criteria to ease and standardize the diagnostic process, especially in the early stages of the disease. The most widely recognized criteria come from the British Neurological Disorders Bank and the National Institute of American Neurological Association and Stroke. The Kingdom criteria require bradykinesia plus either rigidity, tremor, or postural instability. Other possible causes of these symptoms need to be ruled out. Finally, three or more of the following supporting features are required during the onset or progression of the disease: disease on only one side of the body, tremor at rest, asymmetry of motor symptoms, and response to levodopa therapy for at least five years. When diagnoses of Parkinson's disease are examined by autopsy, movement disorders are found to be an average of 79.6% accurate at initial assessment and 83.9% accurate after their diagnosis has been refined at follow-up examination. When clinical diagnoses performed primarily by nonpsychologists are examined by autopsy, average accuracy is 73.8% and 82.7% of diagnoses using brain bank criteria. A task force of the International Parkinson's and Movement Disorders Society has proposed diagnostic criteria for Parkinson's disease, as well as research criteria for the diagnosis of prodromal disease, but they require validation of the more established criteria. Computed tomography is usually It appears normal in people with Parkinson's disease, and MRI has become more accurate in diagnosing the disease over time, specifically iron-sensitive T2* and magnetization-weighted MRI at at least 3T, both of which can show the absence of the characteristic "swallow tail" imaging pattern in the dorsolateral substantia nigra. In a meta-analysis, the absence of this pattern was 98% and 95% specific for this disease. Diffusion MR imaging shows the potential to differentiate between Parkinsonism and Parkinson's plus syndrome, although its diagnostic value is still under investigation. CT and MRI are also used to rule out other diseases that can be secondary causes of parkinsonism, most commonly encephalitis and chronic brain insults, as well as less common entities such as basal ganglia tumors and hydrocephalus. Dopamine-related activity in the basal ganglia can be measured directly with PET and SPECT scans. The detection of decreased dopamine-related activity in the basal ganglia can rule out drug-induced parkinsonism, but decreased dopamine-related activity Basal ganglia dopamine in both Parkinson's and Parkinson's Plus disorders is not reliable in distinguishing Parkinson's disease from other disorders. Exercising in middle age may reduce the risk of Parkinson's disease later in life. Caffeine also appears to be protective against Parkinson's disease and shows a greater reduction in risk than occurs with a higher intake of caffeinated beverages such as coffee. People who smoke cigarettes or use smokeless tobacco are less likely than nonsmokers to develop Parkinson's disease, and the more tobacco they use, the less likely they are to develop it. It is not known what underlies this effect. Tobacco use may actually protect against Parkinson's disease. Antioxidants, such as vitamin C and vitamin E, have been suggested to protect against the disease, but study results have been inconsistent and no positive effect has been demonstrated. Results regarding fatty acids have been inconsistent, with studies reporting different protective effects and increased risk effects. There have been preliminary indications that the use of anti-inflammatory drugs and calcium channel blockers may be protective. A 2010 analysis found that nonsteroidal anti-inflammatory drugs, NSAIDs, were associated with a 15 percent At least reduce the incidence of Parkinson's disease progression. There is no cure for Parkinson's disease, but medications, surgery and physical therapy can provide relief to patients and are much more effective than treatments available for other neurological disorders such as Alzheimer's disease, motor neuron disease, Parkinson's syndrome and multiple sclerosis. The main families of medications useful for treating motor symptoms are levodopa, dopamine agonists and MAO-B inhibitors. The stage of the disease and age at onset of the disease determine which group is most useful. Three stages can be distinguished: an initial stage where the individual with the disease has developed some disability requiring drug therapy, a second stage associated with the development of complications related to the use of levodopa, and a third stage with symptoms unrelated to dopamine or levodopa deficiency. Treatment in the first stage aims at an optimal trade-off between symptom control and treatment of side effects. Levodopa can be delayed initially by using other medications such as MAO-B inhibitors and dopamine agonists instead of levodopa itself, in the hope of delaying the onset of complications due to the use of levodopa. However, levodopa remains the most effective treatment for motor symptoms and should not be delayed in patients whose quality of life is impaired by those symptoms. Dysfunction is associated with Levodopa is more potent with the duration and severity of the disease, so delaying this treatment is not the best solution in this case. In the second stage, the goal is to reduce the symptoms of Parkinson's disease while controlling fluctuations in the drug's effect. Abrupt withdrawals from the drug or overuse must be managed. Oral medications are not sufficient to control symptoms and therefore surgery, deep brain stimulation, subcutaneous injections of apomorphine and intestinal dopa pumps can be of benefit. The third stage presents many difficult problems requiring a variety of treatments for psychological symptoms, orthostatic hypotension, bladder dysfunction, etc. In the final stages of the disease, care is provided to improve the quality of life. Levodopa has been the most widely used treatment for more than 30 years. L-DOPA is converted to dopamine in neurons by dopa-decarboxylase. Since motor symptoms result from a lack of dopamine in the substantia nigra, the use of L-DOPA temporarily reduces motor symptoms. Only 5-10% of L-DOPA crosses the blood-brain barrier. The rest is often converted to Dopamine elsewhere, causing a wide range of side effects including nausea, dyskinesia. Carbidopa and benserazide are dopa decarboxylase inhibitors that inhibit the formation of dopamine elsewhere, thereby minimizing the side effects of treatment as much as possible. They inhibit the metabolism of L-DOPA elsewhere, thereby increasing the delivery of levodopa to the central nervous system. Current inhibitors are carbidopa/levodopa and benserazide/levodopa. Tolcapone inhibits the enzyme catechol-O-methyltransferase, which degrades dopamine and levodopa, thereby prolonging the therapeutic effects of levodopa. Tolcapone is used, in combination with peripheral dopa decarboxylase inhibitors, to increase the therapeutic potency of L-DOPA. However, this treatment is limited, due to its potential side effects such as liver failure. A similar drug, entacapone, has not been shown to cause significant changes in liver function and maintains adequate COMT inhibition over time. Entacapone can be used as a treatment or in combination Along with carbidopa and levodopa, the results of using levodopa work to reduce the body's own formation of L-DOPA, in the long term treatment can cause the development of motor complications characterized by involuntary movements, motor dysfunction, and fluctuations in response to medications. When this happens, a Parkinson's patient goes from a patient who responds very well to treatment and has a noticeable improvement in the disappearance of symptoms of the disease to a patient who does not respond at all to treatment and the appearance of the disease symptoms in a bad way. For this reason, Parkinson's patients are given as low doses of levodopa as possible to reduce this problem. Delaying the initiation of drug treatment, rather than using alternatives for some time, is also common to avoid this problem. The previous strategy to reduce motor complications was to withdraw L-DOPA from patients for some time. But it was a bad thing because it could bring serious side effects such as the syndrome. Most patients eventually need levodopa and later on motor complications will appear. The phenomenon of pathological complications due to the use of treatment is called in English and is an almost constant result of sustained levodopa treatment in patients with Parkinson's disease. Stages Immobility and disability associated with depression. All of these symptoms are responsible for the treatment, and despite all the problems caused by pharmacological agents in Parkinson's patients, evidence is presented to indicate the importance of treating with levodopa. Redistributing the doses of levodopa to smaller and more frequent doses may be useful in controlling oscillations in some patients. Restricting dietary protein and using selegiline hydrochloride and bromocriptine may also temporarily improve motor fluctuations. A new approach to treatment involves the use of apomorphine subcutaneously, and the release of small amounts of levodopa with a peripheral dopa decarboxylase inhibitor. This helps reduce complications resulting from the use of L-DOPA. The dopamine agonist has a similar effect to levodopa because it binds to dopamine receptors in the brain. Dopamine agonists were initially used for patients with L-DOPA treatment problems and dyskinesia as an adjunct to levodopa, but are now used mainly on their own as a first-line treatment for motor symptoms with the aim of delaying motor complications. Dopamine agonists include: bromocriptine, Pergolide, pramipexole, ropinirole, piribedil, cabergoline, apomorphine, lisuride. Dopamine agonists have many side effects, albeit mild, such as drowsiness, hallucinations, insomnia, nausea, constipation. Sometimes, side effects occur even at the lowest clinically effective dose, leading the physician to look for a different agonist. Compared to levodopa, dopamine agonists delay motor complications, and control symptoms worse than levodopa. However, they are usually effective enough to manage symptoms in the early years. Dopamine agonists are also more expensive. Dopamine agonists at high doses cause impulse control disorders. Dyskinesias with dopamine agonists are rare in younger patients, and more common in older patients. All of this illustrates the importance of dopamine agonists as a first-line treatment for Parkinson's disease over levodopa. Apomorphine, a dopamine agonist that is not taken orally, can be used to reduce motor loss in the later stages of the disease. Since secondary effects such as confusion Hallucinations are not uncommon with apomorphine treatment, and patients should be closely monitored. Apomorphine can be administered by subcutaneous injection using a small pump carried by the patient. A low dose is administered automatically throughout the day, thus limiting fluctuations in motor symptoms by providing consistent doses of dopamine agonists. When using an apomorphine pump, the injection site should be changed daily to avoid nodules forming. Apomorphine is also available in large doses as an autoinjector pen used for emergency dosing such as falls or first thing in the morning. Nausea and vomiting are common with apomorphine, and may require domperidone. In a study evaluating the efficacy of dopamine agonists compared to levodopa, the results showed that patients who took dopamine agonists were less likely to develop dyskinesia, dystonia, and movement fluctuations, although they were more likely to discontinue treatment due to negative side effects such as nausea, constipation, etc. MAOIs work by increasing the level of dopamine in the basal ganglia. They inhibit monoamine oxidase-B, which By breaking down dopamine released from neurons. Therefore, reducing MAO-B leads to higher amounts of L-DOPA. Like dopamine agonists, MAO-B inhibitors improve motor symptoms and delay the need to take levodopa as a monotherapy in the early stages of the disease, but these inhibitors produce more negative effects and are less effective than levodopa. Their effectiveness in the advanced stage of the disease is also poor. The metabolites of selegiline include: L-amphetamine and L-methamphetamine. This may lead to side effects such as insomnia. Another side effect can be inflammation of the mouth. Unlike other monoamine oxidase inhibitors, foods containing tyramine do not cause hypertensive crisis. Some evidence suggests that other drugs such as amantadine and anticholinergics may be useful as treatments for motor symptoms in early and late Parkinson's disease, but these drugs are not considered the first-line treatment for the disease. In addition to motor symptoms, Parkinson's disease is accompanied by a range of different symptoms and different compounds are used to improve some of these problems. An example of this is the use of clozapine For psychosis, cholinesterase inhibitors for dementia, and modafinil for drowsiness. A preliminary study suggests that taking donepezil may help prevent falls in Parkinson's patients. Donepezil boosts levels of the neurotransmitter acetylcholine, and is currently the approved treatment for the cognitive symptoms of Alzheimer's disease. The introduction of clozapine represents a major breakthrough in the treatment of psychotic symptoms of Parkinson's disease. Before the introduction of clozapine, treatment of psychotic symptoms relied on dopamine reduction therapy or treatment with first-generation antipsychotics, all of which were detrimental to motor function in patients. Atypical antipsychotics useful in treatment include quetiapine, ziprasidone, aripiprazole, and paliperidone. Clozapine is thought to have the highest efficacy and fewest side effects. Parkinson's disease used to be treated with surgery, but after the discovery of levodopa, surgery was limited to only a small number of cases. Studies in the past few decades have led to significant improvements in surgical techniques, and surgery is being used again in people with advanced Parkinson's symptoms who are no longer treated. Medication is sufficient for them. Less than 10% of Parkinson's patients qualify as suitable candidates for surgical response. Three different mechanisms of surgical response for Parkinson's disease are: , deep brain stimulation, or restorative surgery. Target areas for deep brain stimulation include the thalamus, globus pallidus, or subthalamic nucleus. The neuronal lesion is destroyed by heat, and parts of the brain associated with producing parkinsonian neurological symptoms are destroyed. Procedures generally involve thalamotomy and/or globus pallidus. For the thalamus, a portion of it is destroyed, particularly the ventromedial thalamic nucleus (nucleus pallidus), to suppress tremor in 80-90% of patients. If akinesia is evident, the site of ablation is the subthalamic nucleus. In patients with akinesia or